| Karen E. Harris, MD
This fall, ACOG District XII kicked off three new state-wide initiatives to improve maternal health. Hospitals, physicians, and many others started Hypertension in Pregnancy and Antenatal Steroids
Pilot Projects. In addition, there was the inaugural Prematurity Summit sponsored by the March of Dimes. These are places where you as physician leaders can get involved in ACOG quality improvement initiatives. I’ll also review even more opportunities for you to become involved and make a difference in your community.
On Sept. 18, more than 50 individuals from 15 Florida hospitals met in Orlando to launch a one-year pilot aimed at improving antenatal corticosteroid treatment (ACT) utilization. Florida is one of March of Dimes’ “Big 5” states that are the most populous in the nation, delivering nearly 40 percent of babies in the U.S. The goal of ACT is to reduce neonatal morbidity and mortality by reaching 100 percent administration to at risk mothers 23 to 34 weeks gestation within the optimal timing or “sweet spot” (24 hours to seven days prior to preterm delivery). While ACT use is high, administration during this optimal time period is often not met. Also there is wide variation in ACT administration, with any corticosteroid dose being given to 70 to 95 percent of eligible patients. This is clearly standard of care, but we still have not reached our goal of every baby receiving the optimal treatment.
District XII received a grant from ACOG for the Alliance of Innovation on Maternal Health (AIM) project to reduce severe maternal morbidity and mortality. AIM is a national partnership of organizations working cooperatively on specific projects, such as hypertension in pregnancy, obstetric hemorrhage, and reducing the first cesarean section. On Nov. 6, 33 Florida hospitals and one hospital from Colombia (yes the country!) attended the kickoff of the Hypertension in Pregnancy (HIP) project to improve proper screening, diagnosis, and management of hypertensive disorders related to pregnancy. Complications from hypertension still account for about 15 percent of maternal deaths in our state and are one of the leading preventable causes (OB hemorrhage being the other leading cause). I know I have had to relearn how to take blood pressure (BP) in pregnancy. No longer do you lay someone on their side to see if their BP goes down. You treat based on the sitting BP, and treat quickly, within 30 minutes of a systolic of 160 or a diastolic of 105. Don’t wait to see if it gets better and don’t treat the BP with magnesium sulfate. If any of this seems new or foreign, please read the ACOG monograph on Hypertension in Pregnancy that came out in November 2013. Also, please read the new Florida Toolkit on the Florida Perinatal Quality Collaborative (FPQC) website, which is a terrific resource.
The third major initiative that launched this fall was the Florida Prematurity Summit that took place on November 10. The March of Dimes partners met at the University of South Florida Center for the Advanced Medical Learning and Simulation (CAMLS) in Tampa. The summit explored the extent, risk factors, and consequences of preterm birth in Florida and began to develop long-term strategies to reduce the rates in Florida. Preterm birth presents a significant burden to individuals and society and is the leading cause of neonatal death and death in children under the age of 5 years old. There is often developmental delay and disability for survivors. Florida received a “C” on the March of Dimes Prematurity Report Card this year with a state preterm birth rate of 9.9 percent. While an improvement from 11.2 percent in 2005, it is still higher than the national goal of 8.1 percent for 2015, and the 2030 goal of 5.5 percent. In addition, the black/white disparity is increasing in our state. There will be many opportunities for you to participate in this important project, which is expected to last approximately five years.
There are 48 of the 117 birthing hospitals in Florida working on either HIP or ACT. The majority of you will be at one of these facilities, so please pitch in and become a champion for improving the health of our mothers and babies. Another opportunity to get involved is as a member of the March of Dimes local Board. With the emphasis on prematurity prevention, your leadership is needed to explain the medical side of premature birth and the new research findings to the lay members of the organization. The mission of this organization is on improving maternal/child health. I suggest you approach your local March of Dimes organization and ask to be on the Board of Directors. It is only one meeting a month. I serve on my local board and love working with that great group of people. We also need physicians to get involved with their local Healthy Start Coalition. Again, call and ask how you can help and likely you will be asked to join their Board.
Lastly, you are needed at the Florida Medical Association (FMA) Annual Meeting in the House of Delegates in August 2016. This is where the legislative agenda for the FMA is formed, and it starts the influence for the House of Medicine in Tallahassee. It also influences our delegates to the American Medical Association, and therefore our national legislative priorities. If you don’t like what happens in Tallahassee or Washington, come join me at the FMA Annual Meeting by becoming a Delegate from your county medical society. Many counties do not fill their quota of delegates each year so there is plenty of room. I will be there, and I hope you will join me in promoting our legislative agenda.
So get involved! Become a champion for HIP or ACT in your hospital and ask your hospital to join one of our future projects if they are not involved now. It takes your leadership to pull the hospital along to implement ACOG quality and safety initiatives. Watch for announcements coming out to help with the Prematurity Prevention Campaign. Join the March of Dimes or Healthy Start Boards. And join me at the FMA House of Delegates next summer, and then join me in celebrating our success at the ACOG District XII 2016 Annual District Meeting August 12–14 at the Hilton Orlando Bonnet Creek.