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A Statewide Progestogen Promotion Program in Ohio.

Jay D Iams1, Mary S Applegate, Michael P Marcotte

  • 1Ohio Perinatal Quality Collaborative, Cincinnati Children's Hospital Medical Center, and TriHealth, Cincinnati, The Ohio State University and the Ohio Department of Medicaid, Columbus, Aultman Hospital, Canton, MetroHealth, Cleveland, and Miami Valley Hospital, Dayton, Ohio.

Obstetrics and Gynecology
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PubMed
Summary
This summary is machine-generated.

Progestogen therapy significantly reduced early preterm births in Ohio. This quality improvement project achieved a sustained reduction in singleton births before 32 weeks of gestation, particularly for women with prior preterm birth.

Keywords:
Progesteronepreventionpreterm birth

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Area of Science:

  • Maternal-fetal medicine
  • Public health interventions
  • Quality improvement in healthcare

Background:

  • Premature birth remains a significant public health concern, necessitating effective prevention strategies.
  • Progestogen therapy is a known intervention to reduce the risk of recurrent preterm birth.
  • Systematic implementation challenges can hinder the widespread adoption of evidence-based therapies.

Purpose of the Study:

  • To promote the use of progestogen therapy for reducing premature births in Ohio.
  • To achieve a 10% reduction in premature births through a statewide quality improvement initiative.
  • To identify and address barriers to progestogen therapy uptake in eligible pregnant women.

Main Methods:

  • A quality improvement project involving 20 large maternity hospitals, Ohio Medicaid, and service agencies.
  • Implementation of protocols to identify eligible women and streamline progestogen prescription.
  • System-level changes to improve Medicaid eligibility, coverage, communication, and treatment protocols.
  • Analysis using statistical process control and generalized linear mixed models to assess impact.

Main Results:

  • Tracking of 2,562 eligible women revealed barriers including late entry to care and communication gaps.
  • Births before 32 weeks of gestation decreased by 8.0% in participating hospitals and 6.6% overall.
  • Significant reductions in births before 32 weeks were observed for women with prior preterm birth (20.5% overall), African American women (20.3%), and women on Medicaid (17.1%).
  • A program-associated 13% reduction in births before 32 weeks for women with prior preterm birth was confirmed after adjusting for risk factors.

Conclusions:

  • The Ohio progestogen project successfully reduced singleton births before 32 weeks of gestation.
  • The observed reduction was sustained, indicating the effectiveness of the quality improvement approach.
  • Targeted interventions and system-level changes are crucial for improving preterm birth outcomes.