Page 46 - 2012-may-jun

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46
Healthcare Journal of BATON ROUGE  
MAY / JUN 2012
created for delivering a healthier generation of Louisianians.
In many hospitals, unnecessary inductions and caesarean sec-
tions occur before 39 weeks gestation and lead to increases in neo-
natal intensive care (NICU) admissions. These inductions not only
lead to increased costs, but overwhelming evidence indicates they
also harm mothers and babies. Last July, the Louisiana Hospital
Association (LHA) joined me in asking all of our state’s birthing
hospitals to end this practice. I’m proud to report that every single
birthing hospital in the state has pledged to do so. An early pioneer
of this policy, Woman’s Hospital in Baton Rouge, can attribute a
20 percent decrease in NICU admissions to the change in practice.
Since January 2011, 14 hospitals have voluntarily reported data
on these efforts. These hospitals are part of the Louisi-
ana Perinatal Care Collaborative, a partnership
with the Institute for Healthcare Improve-
ment (IHI). Data through February 2012
show that these hospitals have gone
from an average of 15 to 7 percent for
elective deliveries prior to 39 weeks.
We expect that number to continue
to shrink.
We anticipate seeing this kind of
improvement across the state and
we’ll have the data to back it up. In
March, DHH launched a new tracking
system to collect data on births that occur
before the 39th week. The new systemwas devel-
oped as an enhancement to the existing Louisiana Elec-
tronic Event Registration System (LEERS), the state’s web-based
vital records system that captures data related to birth, death,
fetal death, and marriage and divorce records. Now, whenever a
birth occurs before the 39th week, the hospital will report it. If
the birth was induced, they’ll provide the reason for the medical
necessity of the early induction. With these data, DHH can create
a real-time record of why preterm deliveries happen in Louisiana
and drive targeted policy solutions to address it.
We also recently announced a partnership with LHA to stream-
line the ordering process for 17 Hydroxy-Progesterone, more com-
monly referred to as 17P. Research has shown that hormone treat-
ment with 17P is effective in reducing the rate of repeat preterm
birth by approximately 33 percent in appropriate candidates. Last
year we made a policy change to allow Medicaid to pay for the ad-
ministration of 17P, but according to our records providers are not
billing appropriately and are vastly underutilizing the medication.
In partnership with LHA, we’ve launched a website (www.17PLA.
org) to ease the ordering process so that every eligible woman in the
state of Louisiana will get the preventive care she needs to avoid a
pretermbirth. We’ve also engaged each of the five BAYOUHEALTH
plans to ensure that their members have access to the treatment
and it is considered in their care planning process.
We each own our own health, but opportunities to address
healthy behaviors among women are largely missed. Smoking
and alcohol use are important determinants of health status and
a major contributor to prematurity and low birth weight. In 2009,
twenty-two percent of women in Louisiana age 18-44
reported smoking and 13 percent reported binge
drinking in the past month. Also troubling,
results of screening programs show the
rates of clinically significant depression
symptoms in pregnant and postpar-
tum women are approximately 15-20
percent in Louisiana. That’s why we
are piloting a new program called the
Louisiana Health Assessment and Re-
ferral Tool, or LaHART. We are work-
ing with approximately 30 pilot provid-
ers who will have access to an innovative
web-based tool to screen women for tobacco,
drug or alcohol use; signs of domestic violence;
and depression. Providers will then be able to conduct
brief interventions and refer them to the appropriate services, all
with the ability to bill and be reimbursed for this service. This pilot
is being conducted in close coordination with our BAYOUHEALTH
plans and Magellan, the statewide managing organization for be-
havioral health services.
These are all part of our comprehensive strategy to tackle birth
outcomes in our state. Together, we can ensure that the next gen-
eration of Louisianians has the best chance from the start to lead
a long, healthy, and productive life. Keep up with this project and
other news at our website (dhh.louisiana.gov), by following us on
Twitter (@La_Health_Dept), and “liking” us on Facebook.
Bruce D. Greenstein is Secretary, Louisiana Department of Health and
Hospitals
Secretary’s
Corner