Transcript Slide 1

State of the
Hudson Valley Region
James F. Smith, Jr., MD
Chief of Perinatal Medicine
Westchester Medical Center/NYMC
Who is here?
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Regional Perinatal Center
Affiliate Hospitals
Regional Perinatal Forum
Perinatal Networks (LHVPN, MISN)
County Departments of Health
March of Dimes
Other Regional Stakeholders
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Who are all these people?
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Regional Perinatal Center
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Advanced perinatal/neonatal services
Teaching
Research
Outreach
Management of databases for affiliate hospitals
RPC — Our Affiliates
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Orange Regional Medical
Center
St. Luke’s
Good Samaritan
Bon Secours
St. Anthony’s
Vassar Brothers
Putnam
Hudson Valley
Phelps
St. John’s Sound Shore
Our Lady of Mercy
St. Francis
Sound Shore
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2007
About 17,534 deliveries!
Mini-Grant Recipients
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Lower Hudson Valley Perinatal Network
(LHVPN)
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Planned Parenthood Hudson Peconic, Inc.
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LHVPN Community Health Education Day (CHED)
Increasing Access to Prenatal Care in Westchester
County for Under-served, Low Income & Spanish
Speaking Women (BROCHURE)
Hudson Valley Hospital Center Planned
Parenthood Hudson Peconic, Inc.
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Traveling Health Fair
Regional Perinatal Forum
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Collaboration between the RPC and:
 Perinatal Networks - CPPSN
 Affiliate Hospitals
 Regional Non-Hospital Providers
 Relevant Non-Provider Groups
Insurance
 Intervention programs
 March of Dimes
 Community Based Organizations
 County Departments of Health
 Others
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Comprehensive Prenatal Perinatal
Services Network
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“CPPSN”
Community Based Organizations
Organize perinatal information
 Facilitate access to health care systems at local level
 Improve regional perinatal outcomes
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Comprehensive Prenatal Perinatal
Services Network (CPPSN)
• Maternal Infant Services Network
• Lower Hudson Valley Perinatal Network
NYS Perinatal Health
Infrastructure
Clinical Services
Prevention Services
Regional Perinatal
Centers
Perinatal
Networks
Regional
Perinatal Forum
Hudson Valley Maternal Overweight
45
40
35
30
25
20
15
10
5
0
Dutchess
Orange
Putnam
Rockland
Sullivan
Westchester
Ulster
Nation
% Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data,
Bureau of Biometrics and Health Statistics
Hudson Valley Maternal Overweight
by Race and Ethnicity
60
White
Black
Hispanic
50
40
30
20
10
0
Dutchess
Orange
Putnam
Rockland
Sullivan
Westchester
Ulster
% Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data,
Bureau of Biometrics and Health Statistics
Prenatal Care at WMC over Time
45%
40%
Percent of Deliveries
35%
30%
25%
20%
15%
10%
5%
0%
First Trimester Prenatal Care
Adequacy of Prenatal Care
2006
Source: EBC Data 2006, 2007
2007
Source: EBC Data 2007
Source: EBC Data 2007
Total Cesarean Births
60%
53.10%
50%
Percent of All Births
45%
40%
35.80%
48.10%
47%
37.10%
35.30%
39.20%
37.10%
34.50% 35.30%
32.10%
30%
25.20%
20% 17.40%
10%
PC
To
ta
lR
ge
ra
n
O
LM
O
ny
A
nt
ho
rs
St
.
Se
co
u
ke
's
B
on
Lu
St
.
W
M
C
sa
r
Va
s
e
Sh
or
nd
So
u
Jo
hn
's
m
Source: EBC Data 2007
St
.
Pu
tn
a
lp
s
Ph
e
Va
lle
so
n
H
ud
G
oo
d
Sa
m
y
0%
-----National rate in red for primary c/s is 31%
Primary Cesarean Births Across Network
35.0%
31.7%
29.1%29.7%
30.0%
27.2%
23.5%
25.0%
% of Live Births
26.9%
24.9%
21.3%
20.7%
20.0%
18.3%
18.1%
18.4%
15.0%
10.0%
9.9%
10.0%
5.0%
Source: EBC Data 2007
P
O
LM
he
lp
s
P
ut
S
na
ou
m
nd
S
ho
S
t.
r
An e
th
on
y
S
t.
Jo
hn
s
S
t.
Lu
ke
s
V
as
sa
r
W
To
M
C
ta
lR
eg
io
n
B
on
S
ec
ou
G
oo rs
d
Sa
m
H
ud
so
n
O
ra
V
ng
e
R
eg
0.0%
-----National rate in red for primary c/s is 24.3%
Celebrity Role Models
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“Britney's
scheduled Sept. 15
C-section was
moved up a day
after she began
experiencing early
contractions.
Celebrity Role Models
Trends and Incidence of Cesarean Delivery
Electronic Fetal Monitoring?
Acute Tocolysis
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Effective in delaying delivery up to 48
hours
24 to 34 weeks
 Steroid administration
 Consider transport to RPC
Magnesium Sulfate
Tocolytics
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Lyell, et al. Obstet Gynecol 2007; 110:61-7
Magnesium vs. Nifedipine
Primary outcome—prevention of preterm
delivery and uterine quiescence for 48 hours
Tocolysis
Outcome
Primary *
Magnesium
87%
Nifedipine
72%
7.6%
57%
11%
8.0%
57%
8%
GA at del.
35.8 w
36.0 w
Newborn LOS *
8.8 d
Del
Del
<48 h
<37 w
<32 w
4.2 d
Percent Survival of Admitted Babies by Gestational Age over 4 years
100
90
80
Percent
70
2004
2005
2006
2007
60
50
40
30
20
10
0
<24 weeks
24-25
weeks
26-27
weeks
28-31
weeks
32-36
weeks
Gestational Age
Source: SPDS- NICU Module 2004-2007
37-42
weeks
total
2007 Inborn
100.0%
90.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
< 24 w eeks
24-25 w eeks
26-27 w eeks
28-31 w eeks
32-36 w eeks
37-42 w eeks
Total
Ge s tation Age
2007 Outborn
100.0%
90.0%
Percent of Outborn Admissions
Antenatal
Steroid Use,
SPDS
NICU
Module
Data
Percent of Inborn Admissions
80.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
< 24 weeks
24-25 weeks 26-27 weeks 28-31 weeks 32-36 weeks 37-42 weeks
Ges tational Age
Total
Summary
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EBC Outcomes:
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As Regional Center, sicker mothers, more c/s, and higher
prematurity rates
Regional c/s rates vary by center
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EBC Data Quality
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Future directions
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Fetal Diagnostic and Health Center
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Multispecialty diagnostic team
Fetal interventional program
Increased Regional Preconceptual Health
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Awareness
Access
Implementation
Acknowledgements
Thanks to the entire
Hudson Valley Regional
Perinatal Forum Steering Committee
Neonatology
Edmund La Gamma, MD
Heather Brumberg, MD, MPH
Susan Marchwinski, RN, C, MS
Donna Dozor, RN, MS
Clare Nugent, RN, C
MISN
Caren Fairweather, MPS
Stephanie Sosnowski, ICCE
LHVPN
Cheryl Hunter-Grant, MSW
Lorraine Anglin, MPH
Michelle Gordon
Jeet Lund
LHVPN Steering Committee
OB
Howard Blanchette, MD
James Smith, MD
Michael Kessler, MD
State of the
Hudson Valley Region
James F. Smith, Jr., MD
Chief of Perinatal Medicine
Westchester Medical Center/NYMC