March of Dimes Prematurity Collaborative

March of Dimes Big 5 State Prematurity Collaborative 

By Scott D. Berns, MD, MPH, FAAP
Senior Vice President, Chapter Programs
March of Dimes National Office
White Plains, NY 

Together, five states (California, Florida, Illinois, New York and Texas) account for nearly 40 percent of all births and 36.8 percent of preterm births in the United States. Known as the “Big 5”, these states not only share high birth rates, they also face many of the same challenges in implementing programs to improve birth outcomes. Given these similarities, what are the unique opportunities the Big 5 can leverage to significantly impact birth outcomes? In 2006, the March of Dimes began asking how the Big 5 states could identify opportunities and leverage initiatives to impact birth outcomes. This led to a collaboration among the Big 5 states that continues to evolve today. 

The foundation of this collaboration began with a meeting spearheaded by the March of Dimes in 2007. 50 invited Big 5 state representatives from a cross section of provider disciplines, including state maternal and child health leadership, hospital systems, as well as leading prematurity experts participated in a three-day summit to identify potential areas for ground breaking change to reduce preterm birth. Promising programs currently being carried out were shared and relationships were built. However, there was a common challenge articulated throughout the meeting — improving program evaluation to understand the impact programs have on birth outcomes. This desire to obtain better data to validate programmatic efforts sparked the energy and commitment of the Big 5 to continue their collaborative endeavor. 

Now more formally organized, the March of Dimes Big 5 State Prematurity Collaborative is exploring data driven perinatal quality improvement through the development and adoption of evidence based interventions and the data systems and tools required to track changes in specific perinatal issues and indicators. Recent efforts in California, Kentucky, New York, Ohio, North Carolina, and other states have led to innovative population-based data driven approaches that provide information on potentially effective initiatives. Lessons have been learned in states that have implemented such approaches and the Big 5 have reviewed these and other efforts to identify a shared agenda focused on eliminating elective deliveries < 39 weeks. 

Currently, states are working within and in partnership to establish the data mechanisms required to track the growing rate of elective deliveries, reviewing and developing change models and determining implementation strategies needed to bring this initial plan to fruition. Synergy exists around this data driven project which will not only establish an effective programmatic framework but also a network that can be instrumental in facilitating the rollout of future maternal and child health initiatives among the Big 5 states, and perhaps beyond.