Improving Outcomes for Mothers and Babies
Dr. C. Brennan Fitzpatrick discusses how to improve outcomes for mothers and babies, what major factors contribute to infant mortality rate, the goal of Perinatal Levels of Care, and how Indiana is improving outcomes for Indiana’s mothers and babies.
Featuring:
C. Brennan Fitzpatrick, MD, MBA, FACOG
C. Brennan Fitzpatrick, MD, MBA, FACOG is fascinated by the challenges inherent in caring for high risk pregnancies. It requires a firm commitment to lifelong learning and a willingness to take on difficult cases. The rewards are many with no reward greater than seeing mom and baby together and healthy. Transcription:
Deborah Howell: Welcome. We all know how important maternal infant health is, especially in high risk situations. So how can we go about improving outcomes for mothers and babies? I'm Deborah Howell and our guest today is Dr. Brennan Fitzpatrick, Director of Perinatal Medicine and Ultrasound at Deaconess the Women's Hospital. Welcome Dr. Fitzpatrick.
Dr. Fitzpatrick: Thank you. Thank you for having me.
Host: In your mind, what is the goal of perinatal levels of care?
Dr. Fitzpatrick: Well, you know, I think just to put it in a little bit of context, conversations regarding stratification of perinatal health care into complexity based levels. It has been a discussion since the 1970s and it's based on the concept of what we call regionalized healthcare delivery. And the goal of having these perinatal levels of care is to create a system that essentially ensures access to care for all patients of a given population and that it identifies risks early and directs patients to facilities best able to provide necessary care. The result is better adherence to standards of care and more effective utilization of resources.
Host: It sounds like a good idea then. So what does it mean to be a level three obstetric and neonatal facility?
Dr. Fitzpatrick: So there was a consensus statement that was published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology that sort of defined this. And ultimately a level one facility is a facility that deals with just primarily uncomplicated full-term pregnancies. A level two facility is a level one facility with some high risk conditions such as preeclampsia, preterm birth after 32 weeks, babies that weigh more than two kilograms, mild respiratory issues. And then a level three is sort of a combination of level one and level two. And the level three center needs to be able to deal with the full scope of perinatal problems as well as to offer what we call transport services which is to have babies that can be transported from level one centers and level two centers but also provide education, also provide information on outcome, and follow up with the other centers in the region.
Host: Got it. Now, why is this designation so important for our community?
Dr. Fitzpatrick: You know, I think that there is no question that regionalized healthcare delivery improves outcomes and there are decades of data that support that. And really it's about providing the highest level of care within our community while essentially helping the entire region to receive optimal care and distributing resources in such a way that care is delivered efficiently.
Host: And so I guess my follow-up to that would be how has Indiana improving outcomes for Indiana's mothers and babies?
Dr. Fitzpatrick: Indiana has been very, very active over the last 10 years with respect to improving healthcare for moms and babies. Essentially, in 2010 the Indiana State Department of Health went forward with a task force for perinatal levels of care and made recommendations to the State in 2012 or so. And then in 2019 Governor Holcomb signed into law the Perinatal Hospital Services Act, which essentially creates an accreditation procedure for facilities aspiring to be a specific level of care. So doing that. Also being involved in maternal initiatives such as the Alliance for Innovation and Maternal Health. They've developed at a State level a Maternal Mortality Review Committee that goes over specific cases to look for ways to improve care for women in our State. There is a Fetus and Infant Mortality Review Committee as well that also provides information on infant death to help try to find ways to improve care there as well.
Host: And as we all know, information is power. So what is the vision of the Indiana Perinatal Quality Improvement Collaborative?
Dr. Fitzpatrick: Right, so the Indiana Perinatal Quality Improvement Collaborative, their goal is to provide all women of childbearing age with risk appropriate healthcare before, during, and after pregnancy. And they have created a number of working groups over the years that have addressed issues such as preventing early elective deliveries. Essentially working on progesterone for prevention of preterm birth. And currently I think they're getting ready to work on a project addressing hypertension in pregnancy.
Host: Got it. And now what are the major factors contributing to the infant mortality rate?
Dr. Fitzpatrick: Well, I think that that's really a challenging question, you know, when you look at the things that, that most commonly impact infant mortality, birth defects is a big piece of that. Preterm birth, low birth weight, infants, pregnancy complications, things such as sudden infant death syndrome and accidents all impact infant mortality. When you look at it from a social perspective clearly women of lower socioeconomic status struggle with outcomes and they are certainly more at risk for poor outcomes. I think women that lack access to care certainly are at higher risk for worse outcomes. And so it sort of aligns back with what the State is doing to try to ensure that the women in our State, regardless of what their socioeconomic status is have appropriate access to high quality care.
Host: That is wonderful to hear and well overdue. It sounds like Indiana is a bit of the head of the curve there.
Dr. Fitzpatrick: You know, I think that they are working very hard to be that and it is very encouraging. That the State is very much in tune with I think the needs of the women and children in our State.
Host: Well, this is some really, really good information, Dr. Fitzpatrick, thank you so much for all your knowledge around neonatal care and for being with us today.
Dr. Fitzpatrick: Thank you very much.
Host: This is the Women's Hospital, a place for all your life. To schedule an appointment or to learn more about high risk pregnancy and tristate perinatology at the Women's Hospital, head on over to www.deaconess.com/TSP to get connected with one of our providers. This is Deborah Howell. Thanks for listening and have yourself a terrific day.
Deborah Howell: Welcome. We all know how important maternal infant health is, especially in high risk situations. So how can we go about improving outcomes for mothers and babies? I'm Deborah Howell and our guest today is Dr. Brennan Fitzpatrick, Director of Perinatal Medicine and Ultrasound at Deaconess the Women's Hospital. Welcome Dr. Fitzpatrick.
Dr. Fitzpatrick: Thank you. Thank you for having me.
Host: In your mind, what is the goal of perinatal levels of care?
Dr. Fitzpatrick: Well, you know, I think just to put it in a little bit of context, conversations regarding stratification of perinatal health care into complexity based levels. It has been a discussion since the 1970s and it's based on the concept of what we call regionalized healthcare delivery. And the goal of having these perinatal levels of care is to create a system that essentially ensures access to care for all patients of a given population and that it identifies risks early and directs patients to facilities best able to provide necessary care. The result is better adherence to standards of care and more effective utilization of resources.
Host: It sounds like a good idea then. So what does it mean to be a level three obstetric and neonatal facility?
Dr. Fitzpatrick: So there was a consensus statement that was published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology that sort of defined this. And ultimately a level one facility is a facility that deals with just primarily uncomplicated full-term pregnancies. A level two facility is a level one facility with some high risk conditions such as preeclampsia, preterm birth after 32 weeks, babies that weigh more than two kilograms, mild respiratory issues. And then a level three is sort of a combination of level one and level two. And the level three center needs to be able to deal with the full scope of perinatal problems as well as to offer what we call transport services which is to have babies that can be transported from level one centers and level two centers but also provide education, also provide information on outcome, and follow up with the other centers in the region.
Host: Got it. Now, why is this designation so important for our community?
Dr. Fitzpatrick: You know, I think that there is no question that regionalized healthcare delivery improves outcomes and there are decades of data that support that. And really it's about providing the highest level of care within our community while essentially helping the entire region to receive optimal care and distributing resources in such a way that care is delivered efficiently.
Host: And so I guess my follow-up to that would be how has Indiana improving outcomes for Indiana's mothers and babies?
Dr. Fitzpatrick: Indiana has been very, very active over the last 10 years with respect to improving healthcare for moms and babies. Essentially, in 2010 the Indiana State Department of Health went forward with a task force for perinatal levels of care and made recommendations to the State in 2012 or so. And then in 2019 Governor Holcomb signed into law the Perinatal Hospital Services Act, which essentially creates an accreditation procedure for facilities aspiring to be a specific level of care. So doing that. Also being involved in maternal initiatives such as the Alliance for Innovation and Maternal Health. They've developed at a State level a Maternal Mortality Review Committee that goes over specific cases to look for ways to improve care for women in our State. There is a Fetus and Infant Mortality Review Committee as well that also provides information on infant death to help try to find ways to improve care there as well.
Host: And as we all know, information is power. So what is the vision of the Indiana Perinatal Quality Improvement Collaborative?
Dr. Fitzpatrick: Right, so the Indiana Perinatal Quality Improvement Collaborative, their goal is to provide all women of childbearing age with risk appropriate healthcare before, during, and after pregnancy. And they have created a number of working groups over the years that have addressed issues such as preventing early elective deliveries. Essentially working on progesterone for prevention of preterm birth. And currently I think they're getting ready to work on a project addressing hypertension in pregnancy.
Host: Got it. And now what are the major factors contributing to the infant mortality rate?
Dr. Fitzpatrick: Well, I think that that's really a challenging question, you know, when you look at the things that, that most commonly impact infant mortality, birth defects is a big piece of that. Preterm birth, low birth weight, infants, pregnancy complications, things such as sudden infant death syndrome and accidents all impact infant mortality. When you look at it from a social perspective clearly women of lower socioeconomic status struggle with outcomes and they are certainly more at risk for poor outcomes. I think women that lack access to care certainly are at higher risk for worse outcomes. And so it sort of aligns back with what the State is doing to try to ensure that the women in our State, regardless of what their socioeconomic status is have appropriate access to high quality care.
Host: That is wonderful to hear and well overdue. It sounds like Indiana is a bit of the head of the curve there.
Dr. Fitzpatrick: You know, I think that they are working very hard to be that and it is very encouraging. That the State is very much in tune with I think the needs of the women and children in our State.
Host: Well, this is some really, really good information, Dr. Fitzpatrick, thank you so much for all your knowledge around neonatal care and for being with us today.
Dr. Fitzpatrick: Thank you very much.
Host: This is the Women's Hospital, a place for all your life. To schedule an appointment or to learn more about high risk pregnancy and tristate perinatology at the Women's Hospital, head on over to www.deaconess.com/TSP to get connected with one of our providers. This is Deborah Howell. Thanks for listening and have yourself a terrific day.