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First Year Cleveland

Case Western Reserve University School of Medicine
Biomedical Research Building
11000 Cedar Avenue - 4th Floor Cleveland, OH 44106

Phone 216-368-4837
Home About Us FYC Action Teams Addressing Extreme Prematurity

FYC Action Teams

Priority Area: Addressing Extreme Prematurity

(Learn more about what we're doing in this priority area)

GOAL: By the end of 2020, the 2015 preterm birth rate of 14.9 percent will be reduced to less than 10 percent by the end of 2020 (14.9 percent represents City of Cleveland, March of Dimes data).

RESULTS TO DATE: The county's overall preterm birth rate was 14.9 percent in 2015, 11.95 percent in 2018 and 11.63 percent in 2019.*

Action Team 4: Collect data and establish Learning Circles to identify and resolve issues contributing to extreme premature births and infant deaths.

GOAL: Prevent or delay extreme premature births and optimize outcomes for peri-viable births (less than 26 weeks gestational age). 

Recent Accomplishments:  Monthly convenings of OB/GYN, Maternal Fetal Medicine and Neonatology Providers from four hospital systems resulted in identifying consensus-driven, modifiable interventions that may be improved to reduce extreme premature births and racial disparities. Learning circles are helping promote sharing of standardized protocols and potential best practices that can be replicated and disseminated to improve outcomes.

  • A baseline aggregate report of 2013-2017 data on infant deaths was completed in 2018 with four health systems. An in-depth chart review was completed collecting data (mother and infant) for extreme premature births (less than 26 weeks gestational age) occurring in 2018. 2019 data collection and reporting remain a work in progress.
  • Preliminary chart review findings from 2018 are informing the design of prioritized QI interventions at each hospital system. The three areas of focus include:
    • Early access to prenatal care for pregnant women presenting to an ED for evaluation
    • Early establishment of gestational age, pregnancy viability, and determination of pregnancy risk
    • Consistent cervical length screening in all pregnancies receiving prenatal care before 20 weeks

Findings are being shared at OB/GYN Grand Rounds at each health institution, The Cleveland Society of OB & GYN meeting, and with the other First Year Cleveland Action Teams. By improving these opportunity areas, it is estimated that many babies have the potential to be saved per year. FYC Action Team 4 will continue to work with the OEI Workgroup on the issue of EMS transport for pregnant women and other action teams that are studying the patient experience/journey mapping of individuals and families experiencing a loss to identify ways to improve outcomes.

Co-Chairs: 
Rita Horwitz, Better Health Partnership
Brian Mercer, MD, Chair, OB/GYN, The MetroHealth System


Action Team 5: Educate expectant parents and improve access to treatments to help prevent premature birth and ensure healthy pregnancies.

GOAL:  Partner with Maternal and Child Health (MCH) and social service providers to identify opportunities for enhanced service delivery and engagement with MCH population. Engage Cuyahoga County families in the development and implementation of community-driven strategies to improve birth outcomes for women at highest risk for infant death. Educate and engage families to improve maternal and child health outcomes through the provision of evidence based programs and interventions such as but not limited to CenteringPregnancy, 17P, and reproductive health services.

Recent Accomplishments:  

  • Coordinated advocacy efforts to support equitable access to pregnancy-related services in Emergency Rooms in county’s southeast quadrant. Efforts included production of a data brief, petition, creation and dissemination of a palm card to educate families on where to seek emergency room services, presentations at Grand Rounds to educate providers on communication, and presentation to EMS responders with protocol review.
  • Conducted annual county-wide Home Visiting Training with 140 registrants, focused on topics of interest and best practices for Community Health Workers. The agenda featured speakers from five home visiting programs, a presentation on community navigation services, central intake and the new mobile app in development to support families in locating resources.
  • Established 44137 One Community, based on the success of 44128 One Community.
  • Held One Life Community Event to commemorate National Infant Mortality Awareness Month in September, with approximately 250 people attending; almost 30 vendors participated in the resource fair, providing information on their services. Clips from the short film, "Toxic: A Black Woman’s Story" were shared with a facilitated discussion. The event culminated with the annual Baby Buggy Walk which featured information stations for each trimester of pregnancy.
  • Navigation Services: Connected 704 unserved pregnant women to supportive services.

Led By:
Lisa Matthews, Cleveland-Cuyahoga County Ohio Equity Institute
Angela Newman White, Cleveland-Cuyahoga County Ohio Equity Institute

*If you are interested in joining OEI, please contact Angela at anewman@ccbh.net.


Action Team 6: Increase public awareness of LARC and birth spacing guidelines.

GOAL: Work with providers to increase public awareness of birth spacing guidelines, implement One Key Question, and improve access to long-acting reversible contraception (LARC). 

Recent Accomplishments: Outreach to other sites nationally to seek input on training and implementation on One Key Question was conducted. This was followed by training on One Key Question, initiated with a cohort of local home visitors who employ the Parents as Teachers curriculum among Cuyahoga County families. Project is currently being brought to scale.

Chair: 
Melissa Federman, Center for Community Solutions
Lisa Holloway, March of Dimes


Action Team 7: CenteringPregnancy® Model.

GOAL: Increase the number of expectant moms being served through a CenteringPregnancy® model. 

Recent Accomplishments:  Cuyahoga County practice sites supported by the Ohio Department of Medicaid in 2019 include University Hospitals Cleveland Medical Center, Cleveland Clinic, The MetroHealth System, Neighborhood Family Practice, Care Alliance and NEON. It is anticipated that 2,000 participants will be served in 2019.

Co-Chairs:
Celina Cunanan, Cuyahoga County CenteringPregnancy® Coalition
Alison Tomazic, Cuyahoga County CenteringPregnancy® Coalition


Action Team 8: Address social determinants of health.

GOAL: Address social determinants impacting expectant parents by serving over 4,000 pregnant mothers annually in results-driven interventions that address housing insecurity, employment, education, nutritional needs and early access to prenatal care and post care. 

Recent Accomplishments:  Cleveland Department of Public Health MomsFirst, MetroHealth Nurse Family Partnership, NEON Moms and Babies First, Birthing Beautiful Communities, and Fatherhood services are providing home visiting, education and support programs. 

Co-Chairs: 
Faith-based entities, nonprofits, prenatal care providers, Invest in Children, Bright Beginnings, ODH and ODM

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