May 14 2012
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Healthier Moms, Stronger Babies

The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rebekah Gee, MD, MPH, RWJF Clinical Scholars alumna and an assistant professor of public health and obstetrics and gynecology at Louisiana State University (LSU). She is director of the Louisiana Birth Outcomes Initiative.

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Louisiana is a fantastic place to live. It’s one of the most culturally rich and enchanting places in the United States. The state, however, also faces some of the greatest challenges in our nation.

Louisiana has a long history of poverty, poor education, and social problems that affect the health of too many of its citizens. And for women—particularly African American women—the challenges are even greater. We are 49th in the nation in terms of overall birth outcomes, like infant prematurity and mortality, and we get failing grades on report cards that measure those indicators of health.

In 2010, Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals (DHH), recognized the importance of poor birth outcomes as a crucial public health issue—and named it his top priority. We were the first state in the nation to offer birth outcomes this kind of backing from our government officials. In November, 2010, we launched the Birth Outcomes Initiative, which I direct. It engages partners across the state—physicians, hospitals, clinics, nurses—and provides them with the best evidence and guiding principles to achieve change. We have made significant progress already.

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We are working with the state’s hospitals on maternity care quality improvements, including ending all medically unnecessary deliveries before 39 weeks gestation. We have partnered with 15 of the largest maternity hospitals to provide them with the support and resources to make this a reality. Now, every maternity hospital in the state (there are 58) has signed on to the 39-Week Initiative.

Soon, we will be publishing perinatal quality scores—available to the public—so hospitals and physicians are held accountable for outcomes. In our pioneer facilities, we have seen the rates of elective deliveries drop by half. Many facilities have had as much as a 30-percent drop in the number of babies who needed to go to the NICU. The efforts of the Birth Outcomes Initiative are improving lives day after day.

Louisiana is also the first state in the country to modify the birth certificate to allow for easier, real-time collection of birth outcome data on every premature baby delivered. The information we need to monitor for continuous improvement is now available much more quickly. We no longer have to wait months or years, or go through the hospitals to collect it.

In addition to our hospital work, the Initiative is innovating through web-based technology to improve patient care. Physicians can now use a website, created with the help of the state hospital association, to better understand how to secure and pay for services from Medicaid (or other health plans) for their pregnant patients.

Another critical web-based tool allows for easier referral to behavioral health services with the aim of reducing or preventing tobacco use, substance abuse and psychological or adjustment problems facing expectant mothers of all ages.

The Birth Outcomes Initiative at DHH is also working with the Centers for Medicare & Medicaid Services to improve the health of women of childbearing age by reducing some of the risk factors clearly associated with poor pregnancy outcomes. That means a more intense focus on routine screenings and preventive care, home visits, and health promotion well before women become pregnant.

While so much of our work starts with state government and DHH leadership, we rely on institutions and organizations to put it into practice. Our hospitals and providers were working in silos; breaking down these barriers has made for a more effective, realistic approach to improving birth outcomes. Our partners in the public and private sectors are essential and fully on board and championing these changes.

Louisiana is not only a captivating place to live, it is a compelling place to work. The public health challenges we face are so enormous that today we are really just catching up after being so far behind. Currently, this state has demonstrated the will to succeed in the Birth Outcomes Initiative, and will continue working in precise and passionate ways to create meaningful change for the women who need it the most.

We know there is nothing more important to a state than the health of the next generation, and Louisiana is now first in prioritizing this issue at the highest levels.

Read more about the Robert Wood Johnson Foundation Clinical Scholars program.

Tags: Clinical Scholars, Early Childhood Development, Family and Social Support, Louisiana (LA) WSC, Research & Analysis, Underserved Populations, Voices from the Field, Women and girls, Women's Health Week