One Simple Guideline That Could Reduce America’s High Infant Mortality Rate

BY Jason Kane  July 5, 2013 at 8:14 AM EST


Despite having the highest health care costs in the world, the U.S. is far from the top in preventing infant mortality. Photo By BSIP/UIG Via Getty Images.

I know it just doesn’t sound right, but all of the international research reaches the same conclusion: The United States ranks somewhere around 27th worldwide in infant mortality.

That’s the term used to describe the death of any child under the age of one year.

Common sense would dictate that a country like the U.S. with all its advanced technology — the nation that spends more each year on health care than any developed economy on earth — should be ranked in the top five for countries with the lowest infant mortality rates. But such is not the case.

The Centers for Disease Control recently issued a report that shows U.S. numbers in this area improving. However, health policy experts agree the country still has much work to do. And surprisingly, one of the areas that needs more attention is planned childbirth. Often that decision is not made for medical reasons, but for matters of convenience.

One organization that’s been working hard to lower infant mortality rates in their hospitals is Premier healthcare alliance. I spoke with CEO Susan DeVore about those efforts and what she thinks the challenges are that remain to lower U.S. rates.


BETTY ANN BOWSER: Susan DeVore, thank you so much for joining us. Explain to us what you as a CEO of a major health care network see as the issue here.

SUSAN DEVORE: What we see as the problem is that the rates of infant harm and infant mortality are higher than other countries in the world. And although they have been improving in recent years, we still think a lot of the harm and a lot of the infant mortalities are preventable. And so our whole goal is to get to zero preventable harm and mortality to infants.

BETTY ANN BOWSER: What’s behind these numbers?

SUSAN DEVORE: It’s caused by a number of things. One of the biggest problems is pre-term birth. That is, folks who end up having their babies prior to 37 weeks or prior to 39 weeks.

BETTY ANN BOWSER: Is this by choice?

SUSAN DEVORE: It is often by choice, and I think part of what we are trying to do is bring attention to, in a scalable, national way, some of the things that can be done to prevent potential harm or injury to mothers and infants. And so, yes, I think it is often for convenience, not for clinincal reasons. So we’ve been working very hard to educate and train health systems to implement policies around that and really reduce the number of babies being delivered before 39 weeks.

BETTY ANN BOWSER: You mean to say that there are people who would try to schedule childbirth?

SUSAN DEVORE: Well I’m actually one of seven children. I have 35 nieces and nephews and I have three children of my own and two grandchildren. And before the birth of my most recent grandchild — who was born a few months ago — my daughter said that she and the doctor talked about scheduling her C-section so that I could be in town. And I said, ‘No, you’re not scheduling your C-section before 39 weeks. And if I’m out of town and have to fly back, I’ll fly back.’ For a long time, we thought that it didn’t matter whether it was 39 weeks or 38 weeks or 37 weeks or 40 weeks. The data would indicate it might matter.

BETTY ANN BOWSER: Why does it matter?

SUSAN DEVORE: If a baby is born too early, they could be termed pre-termed, and they typically experience more health problems because they’re not as well developed. So they have a higher liklihood of health problems and a tougher delivery. And also a higher degree of chance of harm or defects or challenges to both the mother and the baby.

BETTY ANN BOWSER: It just seems odd that in a country with so many smart people, there are many who are still making an uninformed decision like this.

SUSAN DEVORE: Well I think the challenge is that there are a lot of smart people, but the evidence, and the proof of the evidence, takes a long time. So if you talk about research and research trials and you talk about proving and debating whether it makes a difference in the results or not, then the challenge is: How do you educate and train the population, and then how do you get adoption? And it’s been shown in all kinds of clinical conditions that the average time it takes to get 95 percent adoption of a new evidence-based protocol is 15 to 17 years. So what we’re trying to do is accelerate the training, the education, the data, the research, so that we can get adoption a lot faster and across the whole country.

BETTY ANN BOWSER: You bring up a personal case that’s really a good example of the problem. In your own daughter’s case, you would think that the last person who would be scheduling a C-section would be the physician.

SUSAN DEVORE: I think that it is a discussion and a debate, and often, I think it comes from the patient, not the physician. The physician ends up agreeing to deliver early because possibly the patient has a desire to do it. So I think it is really a fundamental challenge we all have in transforming the health care system in this country. Doctors and nurses, together with patients, have to have the available information that we both need to make decisions that are more clinically effective and more cost-effective. And I think we are working on it.

BETTY ANN BOWSER: So your philosophy of bringing change to an issue like this one doesn’t have anything to do with passing laws or having the government involved, correct?

SUSAN DEVORE: Yes. Our view of this is that it’s hard for insurance companies to fix this problem, and it’s hard for government to fix this problem. This problem gets fixed if the Department of Health and Human Services would cite that one in four perinatal injuries are preventable.

So what I’ve been doing for the past three years with these health systems across the country is say: What would we do to prevent that one in four harm? And so then we asked: If you were going to induce labor, what is the evidence-based protocol that would get you to the best result to prevent harm? And if you had a situational training process that helped nurses and doctors speak the same language and know how to identify an infant in distress, and manage that challenge consistently, would that reduce the numbers? What we essentially did was say, regardless of any policy or regulation: If we’ve got one in four babies being harmed in a way that could have been prevented, let’s just go to work on that with everything we’ve got.

BETTY ANN BOWSER: So what are you doing in your hospitals that has given you, I gather, some favorable statistics?

SUSAN DEVORE: We have 14 hospitals across 12 states, so we wanted different geographies, different kinds of hospitals. We have teaching hospitals, we have rural hospitals. I’m not a believer that this can’t be done everywhere. So we had a wide variety of hospitals and geogrpahies, with 145,000 mothers in phase one.

We then identified some of the most significant issues that could cause harm to babies. The first one is that the nursing or clinical team doesn’t recognize when an infant is in distress. The second thing is they don’t recognize the need for a timely cesarean. Third, they don’t recognize the need to resuscitate a suffocating baby. Four, they use inappropriate labor-inducing drugs, or they don’t use forceps appropriately. We came up with this through a lot of clinical evidence. But we’ve created these bundles that say: If you’re going to use labor-inducing drugs, you need to do these four things. And if you do these four things, we’re going to give you a checkmark that says you are highly compliant with this bundle. If you don’t do even one of the four things, you don’t get the checkmark.

And then we are measuring how compliant these health systems are with these protocol, and at the same time, we’re measuring how much harm occurs. And what we’ve found over the period of time we’ve been doing this is that with these bundles and with this communication and training work that we’ve done, the rate of harm to the babies in this cohort has been reduced by 25 percent. It works.

BETTY ANN BOWSER: Do you consider 25 percent to be significant?

SUSAN DEVORE: Yes. Injuries that cause infant brain damage have gone down by 25 percent, and if you ask me as a mother and grandmother or even just as a human being whether I think that a 25 percent reduction in infant brain damage is significant, I’d say yes.

BETTY ANN BOWSER: What’s the answer to getting a handle on this problem nationwide, not just in your network?

SUSAN DEVORE: I think the answer is to more rapidly get to the improvement that can drive a change in outcome and cost, have the data to do that and then have a national, scalable way to do it. I mean you’ve got to get to the patients and the providers with data and with improvement ideas. And they’ve got to then be scaled. I think that all physicians want to do this, and I think nurses want to deliver good quality care, and I think patients want it. So I don’t think it’s an issue of incentive to do it. I think it’s just the scalability of a lot of complex and fragmented pieces and parts to our health care system.

BETTY ANN BOWSER: Susan, thank you so much for your time. This has been really interesting.

SUSAN DEVORE: Thank you.