November 21, 2008

Statewide effort seeks to improve care of infants

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A new initiative links neonatal intensive care units from across the state to share data in an effort to improve Tennessee’s poor infant morbidity and mortality rates. (photo by Dana Johnson)

Statewide effort seeks to improve care of infants

At a time of increasingly tight state funding, a determined group of infant health advocates, including several from Vanderbilt, have pulled off a small but important feat.

A program, the Tennessee Initiative for Perinatal Quality Care (TIPQC), received enough state funding to hire staff and begin work this month in an effort to raise Tennessee's poor infant morbidity and mortality rates.

“Perinatal care and decreasing infant morbidity and mortality rates have been a big priority, and this idea of TIPQC is promising,” said Jeanne James, M.D., assistant medical director for the Bureau of TennCare.

James said the Governor's Office of Children's Care Coordination has directed some of its TennCare funds to hire the first staff for TIPQC.

“It has such a lifelong impact for patients and families. We wanted to make sure we found a way to fund this.”

TIPQC is the brainchild of Judy Aschner, M.D., chief of Neonatology at the Monroe Carell Jr. Children's Hospital at Vanderbilt, and her colleagues, but it has quickly grown into a statewide consortium.

“The enthusiasm is great. We already have 15 neonatal intensive care units (NICUs) that have agreed to participate in TIPQC and share data,” said Brenda Barker, the newly hired project manager for TIPQC and its only full-time employee so far.

The goal is for all 27 NICUs in Tennessee, as well as obstetrical practices, to join TIPQC and participate in evidence-based changes in practice to improve prenatal care, reduce infant mortality and reduce complications of preterm birth.

All NICUs are asked to join an existing national quality improvement network called the Vermont Oxford Network (VON) and to share data about NICU practices and outcomes.

TIPQC will develop tool kits for quality improvement projects, teach teams how to implement and monitor changes in their practice and establish a statewide database to analyze the impact of those changes on infant outcomes.

Peter Grubb, M.D., a neonatologist at Children's Hospital, is serving as TIPQC's first medical director.

“We are pleased that the NICUs that have already signed on to TIPQC collectively treat 95 percent of Tennessee's most premature infants,” Grubb said.

Tennessee currently ranks 45th in the nation for infant mortality. The rate of preterm birth in Tennessee increased from 10.8 percent to 12.7 percent between 1994 and 2004 and to 14.7 percent in 2008.

“We are fortunate that VON provides the NICUs such a great starting point. However some of the NICUs in the state are finding it difficult to fund local participation in VON. The obstetrics community faces similar challenges. Encouraging and facilitating participation by the full spectrum of stakeholders will be a central topic at our meeting in March,” Grubb said.

More than 100 participants from across the state turned out for TIPQC's inaugural meeting in November, 2007. Plans for the upcoming TIPQC statewide meeting on March 5 and 6, 2009, are under way.