Whitney Palmer

Healthcare. Politics. Family.

No unnecessary early-term deliveries is goal for hospitals

Published in the July 2012 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Risks rise for moms, newborns with elective deliveries

Evidence is mounting that both mothers and newborns are at heightened risk of health problems following nonmedically necessary early-term deliveries. In response, hospitals nationwide are instituting policies to eliminate the procedure.

In late June, the American Hospital Association board of trustees issued a policy supporting those efforts.

Babies are considered full term between 37 and 41 weeks of gestation. Early-term deliveries occur during the first two weeks of this period. The number of elective early-term deliveries — either by induction or cesarean — nearly doubled to 22.5 percent in 2006, up from 9.5 percent in 1990, according to the most recent data available from the Centers for Disease Control and Prevention.

“Women who are induced in the 37th to 38th week have a significantly higher risk of having a cesarean section than mothers who have spontaneous labor,” according to the Leapfrog Group. “And, given low rates of vaginal births after cesarean sections, these mothers are likely to have additional cesarean sections with increasing risks.”

Citing other studies, the patient safety group goes on to note that babies induced during these early weeks are at higher risk of neonatal mortality and morbidity, including respiratory problems. Length of stay also typically increases for both moms and newborns, who are put in neonatal intensive care units.

To control inductions, Utah’s Intermountain Healthcare educates doctors and patients. A team of nurses, physicians and administrators designed a data-rich program to explain the risks of the procedure, says Teri Kiehn, R.N., operations director of Intermoutain’s women and newborns clinical programs.

They’re succeeding.

“Our elective induction rate dropped from more than 30 percent to 2 percent,” she says. “We’ve made significant inroads, and it’s improving. We were at 1.2 percent, and we’d love to reach zero. It’s a work in progress.”

Physicians who ignore the policy meet with Intermountain’s medical director to review existing best practices and clinical evidence. The goal, Kiehn says, is to reinforce that pre-determining times is risky.

Health officials in Minnesota targeted unnecessary inductions in 2009, according to Jeff Schiff, M.D., medical director, Minnesota Health Care Programs, Department of Human Services. The state has a multistep plan to identify necessary inductions, and 70 out of Minnesota’s 90 hospitals participate.

Proposed inductions are reviewed to decide whether they’re necessary. Providers and patients are informed and talk about the risks of an early-term delivery.

“It’s important to stop thinking birth at 37 weeks is OK,” Schiff says. “Our goal is getting people thinking more than 39 weeks.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2012/0712HHN_Inbox_birthday&domain=HHNMAG


July 11, 2012 Posted by | Healthcare | , , , , , , , , , , | Leave a comment

Good (and healthy) eats!

Published in the July 2012 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

With an eye toward improving population health and combating the obesity epidemic, clinicians at Indiana University Health are bringing an oasis to food deserts in Indianapolis.

“We wanted to increase access to affordable fruits and vegetables in low-income populations because they face challenges to acquiring healthy foods doctors prescribe to patients,” says Lisa Cole, R.N., creator of Garden on the Go and IUH’s Indianapolis Community Outreach manager. “We wanted to be part of the solution and provide access in those neighborhoods.”

Bringing in healthy food meant partnering with a Green B.E.A.N. Delivery, a food delivery service committed to providing fresh, local, organic produce. Since its launch last year, GOTG has grown to 16 weekly stops in community centers, libraries, neighborhood health centers and senior centers where workers select produce for customers with mobility issues, Cole says.

So far, the initiative has been successful. As of late June, GOTG had processed 15,700 transactions with roughly 400 repeat customers. Each $7 purchase, for which customers can use cash, credit, debit or food stamps, includes 1 pound each of bananas, green beans and tomatoes, 3 pounds of potatoes, and a large bunch of greens.

“The food smells and looks good. The bunches of greens are big. The peppers aren’t shriveled,” Cole says. “It’s an important message for the community — they deserve the same quality food you and I purchase. It gives them a better value for their dollar.”

Having easy access to fresh foods has positively impacted community members. For example, after Sandra Bailey began shopping with GOTG last year, her blood sugar levels dropped, making her diabetes more manageable. In addition, as an employee of the Indianapolis Housing Agency, which hosts several GOTG stops, she’s seen similar effects on low-income groups.

IUH researchers recruited 120 shoppers and are tracking their blood sugar, blood pressure, body mass index and food patterns for six months. Twenty of the shoppers will receive specific food-choice guidance from dietitians.

The program also fits with the nonprofit health system’s effort to provide a community benefit, Cole says. Clinicians can monitor what people are buying and provide guidance for improving their health status.

Cole says hospitals can learn from IUH’s experience. Working with for-profit produce companies and using operational dollars makes it easier for initiatives to benefit communities. It’s also important to determine how communities prefer to access produce, such as in trucks or community buildings, to ensure greatest participation.

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2012/0712HHN_Inbox_fooddeserts&domain=HHNMAG

July 11, 2012 Posted by | Healthcare | , , , , , , , , , , | Leave a comment


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