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Perinatal Regionalization
Office of Women’s Health Perinatal Strategic Plan Goals for 2015-2020
- Improve data collection and reporting
- Reduce disparities in access and quality
- Improve coordination of care
- Establish a statewide professional curriculum for all healthcare professionals providing perinatal care
What is Risk Appropriate Perinatal Care (Perinatal Regionalization)?
Infants that deliver at appropriate level facilities are more likely to have better neonatal outcomes. Neonatal mortality is associated with gestational age, low birth weight, congenital malformations, and health problems originating in the perinatal period. The purpose of Risk Appropriate Perinatal Care is to increase the delivery of high risk infants and mothers at appropriate level facilities. Illinois has partnered with The Collaborative Improvement & Innovation Network (CoIIN) to reduce infant mortality, however, Illinois is dedicated to continue with these efforts after CoIIN funding has completed.
Currently, Illinois has a robust perinatal regionalization system that includes 10 Administrative Perinatal Centers that supervise 122 obstetric hospitals in Illinois. This has helped to provide quality care to perinatal patients in Illinois since the perinatal regionalization system inception in 1976. The 10 Administrative Perinatal Centers include:
- The University of Chicago
- Stroger Hospital
- Northwestern Memorial Hospital
- University of Illinois Hospital
- Loyola University
- Rush University Medical Center
- MercyHealth’s Javon Bea Hospital- Riverside
- St. Francis Medical Center
- St. John’s Hospital
- Cardinal Glennon
In Illinois, through the perinatal regionalization system; level I, II, IIE, and III hospitals are evaluated every 3 years by IDPH OWH through perinatal site visits that are facilitated by OWH perinatal nurses and the perinatal network administrators. These site visits follow the Joint Committee on Administrative Rules 640 rule and Part 250 Hospital and Licensing Requirements (see Laws & Rules in the right-hand column).
Level 0 hospitals in Illinois are not required to have a site visit every 3 years, however, the Administrative Perinatal Centers are required to provide education to emergency room physicians and staff for obstetric patients that may show up for delivery.
Level 0 - Hospitals with no obstetric services available.
Level I - Hospitals that provide care to low-risk pregnant women and newborns, operate general care nurseries and do not operate an NICU or Special Care Nursery.
Level II - Hospitals that provide care to women and newborns at moderate risk, operate intermediate care nurseries and do not operate NICU or Special Care Nursery.
Level IIE - Hospitals with Extended Neonatal Capabilities which can provide care to women and newborns at moderate risk and do operate a Special Care Nursery but do not operate a NICU.
Level III - Hospitals that provide care for patients requiring increasingly complex care and do operate a NICU.
The Illinois Department of Public Health’s Office of Women’s Health and Family Services has began efforts to promote the likelihood of infants delivering at appropriate level facilities that are equipped to provide for complex medical needs. These efforts will align with the Healthy People 2020 goal which is the reduction of IMR by 10% in the year 2020.
By July 2016:
- Increase the % of VLBW (<1500 grams) and very preterm (<32 weeks gestation) infants delivering at risk appropriate facilities (Level III+ Neonatal Intensive Care Units) to 90% (or 20% increase relative to state baseline).
- Illinois’ provisional VLBW and very preterm births by appropriate facilities is at 78%. Illinois goal will be to improve to at least 90% by July 2016.
- Increase the % of pregnant women with high risk placental conditions (placenta accreta or placenta previa with prior uterine surgery, placenta percreta), expectant management of preeclampsia with severe features at less than 34 weeks of gestation and severe maternal cardiac conditions receiving care at appropriate facilities (Level III or IV) by 10%.
- Illinois has no current data available for the above information, however, our goal in the Risk-Appropriate Perinatal Care work group is to develop a way to obtain this data for quality improvement of care.
CoIIN update:
On March 24, 2016, Director Shah signed a Declaration of Medical Study for the Very Preterm Review. Providing risk-appropriate care for infants and pregnant/post-partum women is both a national and state priority. Numerous studies have suggested that infant morbidity and mortality are significantly reduced for small or premature infants when they are born in risk-appropriate facilities capable of providing necessary level of care and treatment.
- Action: Very Preterm Review forms will be completed by all Level 0, I, II, and IIE facilities to get a better understanding as to why babies between the gestational ages of 22 0/7 to 31 6/7 weeks are not born at a level III facility. The pilot study will include 2015 births and the hospitals have until June 30, 2016 to provide the completed Very Preterm Review Forms to IDPH. This information will be reviewed by the Illinois Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) group from the results, recommendations will be made for state initiatives to improve infant mortality rates in Illinois. This review will continue through 2020, review forms for the years following 2015 will be due at IDPH on March 31st of each subsequent year.
- Accomplishments: The Illinois CoIIN team was mentioned in the National Institute for Children's Health Quality newsletter, please see link: http://nichq.org/blog/2016/march/improving_perinatal_regionalization_illinois
The Illinois Department of Public Health is in the process of partnering with Healthcare and Family Services to provide all obstetrical providers with an Informational Notice regarding the Risk Appropriate Care for Very Preterm Infants. It is our goal that this will provide awareness to not only the providers, but that the providers will make their perinatal patients aware of this important information.