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In October 2010, the Indiana Department of Health’s (IDOH) Division of Maternal and Child Health (MCH) initiated the Hospital Levels of Care Task Force. Its goal was to ensure that all pregnant patients deliver at a hospital that could provide a risk-appropriate level of care. Because Indiana did not have a formal process for designating levels of care for the state’s 90 birthing hospitals, the Task Force was asked to 1) assess the current level of care definitions; 2) create standard definitions and guidelines for each hospital level of obstetric and newborn care, and 3) make recommendations to the health department and professional organizations on policy needed to improve quality perinatal care and what the next steps should be. The Task Force adopted principles to guide its work:

  • Achieve the best outcomes for mothers and babies;
  • Comply but not exceed the American Academy of Pediatrics (AAP) and American Congress of Obstetricians and Gynecologists (ACOG) national standards;
  • All standards must be grounded in solid evidence;
  • Produce a visionary document.
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    In 2012, the Task Force finalized its recommendations that incorporated AAP and ACOG Guidelines for Perinatal Care that were published in September 2012. A gap analysis was conducted with all Indiana hospitals with obstetric and newborn services to support a self-assessment of their current status compared to the national guidelines. Forty-three percent (43%) of the obstetric units and 32% of the newborn units met the revised guidelines for their self-declared level of care. Based on the results of the survey and the work of the Task Force, Dr. Gregory Larkin, Commissioner of Health, charged the MCH Director to build on the work that began with the Levels of Care Task Force (2011-2012). The Indiana Perinatal Quality Improvement Collaborative (IPQIC) began its official work in 2013. The vision of IPQIC is:

    • All perinatal care providers and all hospitals have an important role to play in assuring all babies born in Indiana have the best start in life.
    • All babies in Indiana will be born when the time is right for both the mother and the baby.
    • Through a collaborative effort, all women of childbearing age will receive risk-appropriate health care before, during and after pregnancy.

    After the election of Governor Mike Pence in 2012 and the appointment of Dr. William VanNess as Indiana Health Commissioner, there was a renewed emphasis on the issue of infant mortality. After a briefing by the MCH staff and a review of the most current perinatal data, Commissioner VanNess identified a reduction in infant mortality rates as the top priority for the Health Department for the next four years. In 2016 Eric Holcomb was elected Governor and was re-elected in 2020. Governor Holcomb continues to include infant mortality reduction as an administrative priority and has challenged Indiana to become the best in the Midwest by 2024 for infant mortality.

    While there have been changes in leadership from Dr. VanNess to Dr. Jerome Adams in 2014, and to Dr. Kristina Box in 2017, the commitment to reduce infant mortality as well as morbidity remains unchanged. The current IPQIC infrastructure involves nearly 450 stakeholders participating in this significant effort to address the issues of infant mortality and morbidity. A few of the successful efforts to date include:

    • the adoption of Levels of Care rules for Indiana birthing hospitals in 2019;
    • The implementation of three toolkits – Perinatal Substance Use, Maternal Hemorrhage and Hypertension;
    • Breastfeeding guidance documents related to safe sleep, reproductive planning and substance use; and
    • Perinatal transport guidelines and conferences

    In 2021, IPQIC engaged in a strategic planning process to identify priorities for the next three-year cycle. Comprehensive data were reviewed, and a new set of goals were established moving into the future:

    Goal I: Ensure all women of childbearing age in Indiana have access to comprehensive, trusted and risk-appropriate health care before, during and after pregnancy.

    Goal II: Ensure that all Indiana parents and caregivers have access to the resources and support they need to ensure their infants thrive and celebrate their first birthday.

    Goal III: All pregnant persons with substance use and/or mental health challenges have access to and receive risk-appropriate treatment and support services

    Goal IV: All pregnant persons receive timely, high-quality, equitable and trusted prenatal care that results in an uncomplicated delivery and a healthy term baby.

    Goal V: All parents receive the support and resources needed post-discharge to meet their individual needs and improve their opportunity to see their child’s first birthday.

    New task forces have been added to existing ones to address the challenges and opportunities that were identified during the planning process. The chart below represents the infrastructure of IPQIC and the priorities established for 2022-2024.

    history chart

    The completed work and ongoing activities of IPQIC are designed to complement the continuing efforts of the Indiana Department of Health (IDOH) to improve outcomes for Indiana’s mothers and babies. The work of IPQIC is focused on both maternal and neonatal mortality and morbidity issues as well as emerging issues that often result in additional task forces and workgroups. IPQIC and its members remain committed to supporting the efforts of IDOH in working actively to promote quality outcomes for Indiana mothers and their babies.

Indiana Perinatal Quality Improvement Collaborative (IPQIC) Governing Council

IPQIC Infrastructure

Prenatal Care

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