Teamwork makes the Dream Work for PTB in Ohio

Individually we are one drop, but together we are an ocean.
— Ryunosuke Satoro

The wisdom underlying the power of teamwork has never been so true as when it is applied to delivering medical care. From restructuring care teams to center around patients and their families to encouraging collaboration between medical centers, improvements in medicine rely on increasing teamwork. A collaborative in Ohio has recently shown the tremendous benefits that can be achieved in the field of obstetrics when groups team up to prevent preterm birth through better access to progesterone treatments. 

Dr. Jay D. Iams of the Ohio State University and Dr. Mary S. Applegate of the Ohio Department of Medicaid led the charge to unite maternity hospitals, prenatal care clinics, Ohio Medicaid, insurance companies, and local service agencies. This statewide collaboration, dubbed the Ohio Perinatal Quality Collaborative (PQC) focused on reducing preterm birth as their first goal. Their new data, published in the February 2017 Green Journal shows the fruits of their labor: a significant reduction in preterm birth at less than 32 weeks.

As a part of the program, clinicians were asked to identify pregnant women who were at high risk of preterm birth, for instance, women with a history of a preterm birth or those with a short cervix. As indicated, clinicians prescribe these women either injectable or vaginal progesterone to lower the risk of preterm birth. Clinicians also notified the Ohio Medicaid agency about the patient. Ohio Medicaid then assigned each woman a care manager, who would help the woman access care and services. For instance, care managers would help to ensure that there were no gaps in Medicaid coverage that could interfere with a woman's ability to access her progesterone treatments. The organizations also worked together on trainings and scientific evidence reviews. 

All in all, 2,562 women were eligible for progesterone treatments from Jan. 2014 to May 2015. A progestogen was prescribed for 64% of these women before 21 weeks and 72% before 25 weeks gestation. The birth rate before 32 weeks gestation decreased by 20.5% for women with a prior preterm birth, 20.3% for African American women, and 17.1% for women on Medicaid. They did not find a change in the overall preterm birth rate (the rate of births before 37 weeks gestation). 

In a recent interview with Ob.Gyn. News, Dr. Applegate said, "We have five managed care plans that are doing a good job by themselves, we have clinicians that are doing a good job by themselves, so just imagine what you could do if you had them working together." The Ohio PQC is a great example of the power of teamwork for improving health outcomes. We want to hear from you! What other areas of OBGYN could benefit from cross-institutional collaborations?