IMPLICIT: Interventions to Minimize Preterm and Low birth weight Infants through Continuous Improvement Techniques
"Preventing prematurity one woman at a time"
We use evidence-based interventions to reduce the risk of prematurity utilizing quality improvement techniques. Our multi-center family medicine collaboration is dedicated to enhancing preconception, prenatal and postpartum care
A multi-center collaboration of family medicine residency programs, the Family Medicine IMPLICIT Network, began in 2003 in order to educate family medicine residents and practicing physicians about primary prevention of low birth weight and preterm birth. Our goal is to reduce the rates of preventable prematurity.
Initially we developed a set of evidence-based prenatal and preconception interventions aimed at primary prevention of prematurity and low birth weight babies. We then restructured curriculum and practice habits to insure use of these interventions using Continuous Quality Improvement (CQI) techniques, including frequent chart reviews and ongoing provider feedback. Over the next 5 years our 16 collaborating residencies will train 480 residents, and care for (using an average of 100 patients per year in each site) 8,000 patients. New practices are invited to join the network and ultimately we plan to share successful interventions and process changes with the medical community at large.
Background: Not all cases of prematurity are preventable, but some are. Premature birth is a serious and vexing healthcare problem and it is on the rise. Prematurity can be devastating to families. It is the leading cause of death in the first month of life and a major risk factor for illness and disability in children. Premature birth can lead to long-term disability, most commonly, cerebral palsy, mental retardation, vision impairment, and hearing loss. Premature births cost U.S. economy more than $26 billion each year, $17 billion of which are medical costs.1
1. Kuehn BM. Groups take aim at US preterm birth rate. Jama 2006;296(24):2907-8
Continuous Quality Improvement is an ongoing process to improve care. It is a process of identifying, and analyzing strengths and problems and then testing, implementing, and revising solutions. CQI is proactive, supports continuous learning, and is dependent upon the active participation of all staff. It is a requirement of a good medical practice and often has a narrow focus over a defined period of time. Over the next few years network members will focus on the appropriate application of prenatal and preconception interventions, or guidelines, designed to reduce the risk of prematurity.
Interventions: The FamMed IMPLICIT Network members reviewed the literature on multiple interventions suspected of reducing prematurity. Based on best evidence, and ease of implementation the following were chosen (available upon request):
Asymptomatic Bacteriuria
Depression
Smoking
Bacterial Vaginosis
Progesterone
Shortened Inter-pregnancy Interval
Domestic Violence (pilot)
Phases:
Past: Evidence evaluation, intervention areas chosen and guidelines written; retrospective data collection (2003-2004), data entry and report generation; institute new processes based on guidelines; prospective data collection (spring 2005); development of web based portal for prospective data.
Ongoing: Measure program adherence to the clinical guidelines: Chart reviews at 15 and 30 weeks of pregnancy and postpartum (data abstraction); data entry into portal; frequent provider feedback (using CQI internally, portal reports externally); change process of care as necessary to insure quality of care; Compare to retrospective data; vet or change existing guidelines; add new guidelines; publish or present early data; incorporate new members; and raise funds necessary to continue the work.
Future: Develop and distribute detailed and useful reports from prospective phase (portal data). Develop internal report/feedback from portal data. Disseminate findings: guidelines, chart updates, data abstraction tools, portal reports, or whole QA package. Present and publish findings.
Existing Funding and Project Support: Family Medicine Education Consortium: Larry Bauer, laurence.bauer@sbcglobal.net
March of Dimes: Janis Biermann, jbiermann@marchofdimes.com; Karla Damus, damus@aecom.yu.edu
Project Leader
Stephen Ratcliffe, M.D. Lancaster General Hospital Family Medicine Residency; sdratcli@lancastergeneral.org
Participating Sites:
Pennsylvania
- Chestnut Hill Family Medicine Residency
- Drexel University Family Medicine Residency
- Good Samaritan Hospital Family Medicine Residency
- Jefferson University, Department of Family Medicine
- Lancaster General Hospital Family Medicine Residency
- Reading Hospital Medical Center Family Medicine Residency
- University of Pennsylvania Family Medicine Residency
- Williamsport Family Medicine Residency
- UPMC-McKeesport Family Medicine Residency
- UPMC-Shadyside Family Medicine Residency
- UPMC-St. Margaret Family Medicine Residency
- WPAHS-Forbes Family Medicine Residency
Maine
- Maine Medical Center Family Medicine Residency
New York
- Beth Israel Family Medicine Residency
- Mid-Hudson Family Medicine Residency (Kingston)
- Ellis Family Medicine Residency (Schenectedy)
Connecticut
- Middlesex Hospital Family Medicine Residency
Maryland - Franklin Square Family Medicine Residency
North Carolina
Mountain Area AHEC Family Medicine Residency
