1. Non-medically indicated delivery prior to 39 weeks gestation
in United States hospitals
Nathaniel G. DeNicola, MD; Andrew J. Epstein, PhD; Sindhu K. Srinivas, MD, MSCE
 Excluded: no L&D unit listed in AHA
database, self-reported no L&D unit, or hospital
only performed emergency deliveries
 Test/re-test reliability: different caller assigned
random selection of 10% of original call list
 Telephone survey with all US L&D units during
an 8 week timeframe: July 1 – August 31, 2012
 Script developed from multi-site focused
interviews with L&D nurses, followed by pilot
trial with 10 hospitals: included study disclosure
 Three callers each assigned random selection of
890 hospitals containing 50 states
 Survey conducted as “cold call” with Charge
Nurse or Nurse Manager on L&D to determine if
the hospital has a specific policy for NMI
delivery < 39 weeks
Methods Results
 The national movement to eliminate NMI
delivery < 39 weeks has prompted many
hospitals to develop specific policies; in our
study the majority, 66.5%, reported a policy.
 Telephone survey via “cold call” to Charge
Nurses or Nurse Managers can be an effective
method for contacting operational points in the
health care system: 8% response rate.
 States with a policy initiative had a significantly
higher proportion of hospitals reporting a
specific policy against NMI delivery < 39 weeks.
Conclusions
 State initiatives – independently or in
coordination with state government –
can serve an important role in
encouraging hospitals to adopt specific
policies.
 Additional studies linking hospital policy
with neonatal outcomes could further
our understanding of hospital policy in
advancing perinatal health.
 The reality of operational hospital
policy may differ from written hospital
policy – investigating this
communication is an important step in
optimizing the benefit of policy design
and implementation.
Policy Implications
 Overall 1,228 Yes-policy hospitals in initiative states (67.8%)
vs. 345 Yes-policy hospitals in non-initiative states (62.1%)
p<0.012; Highest Yes% among self-reported initiative states:
> 1 hospital reported policy initiative in interview p<0.0001.
 Background. Non-medically indicated (NMI)
delivery prior to 39 weeks gestation (<39
weeks) is clearly associated with increased
neonatal morbidity.
 Objectives. To determine the prevalence of US
hospital-level policy that specifically addresses
NMI delivery <39 weeks.
 Methods. Telephone survey of all US labor &
delivery units to determine presence and type
of hospital policy for NMI delivery < 39 weeks.
 Results. 2,367 of 2,641 (89.6%) hospitals
responded: 66.5% “Yes”, 33.5% “No.” States
with policy initiatives reported a higher
proportion of Yes-policy hospitals: 67.8% v
62.1% (p < 0.012). The majority of policy coded
as “hard stop” 68.8%.
 Conclusions. The national movement to
eliminate NMI delivery < 39 weeks has
prompted many hospitals to develop specific
policies. State initiatives represent an
effective approach in policy promotion.
Abstract
 The American College of Obstetricians &
Gynecologists (ACOG) has issued guidelines
against NMI delivery < 39 weeks; however the
practice continues to occur.
Background
1. Determine the prevalence of US hospital-level
policy that addresses NMI delivery < 39 weeks
Objectives
Yes
Hard Stop
Other
No
“Not Done” *
Uncertain
Reviewed by
multiple
investigators
Response Coding
* Respondents volunteered that
NMI was against standard of care
Test / Re-test Reliability
Total hospitals contacted 2,641
Respondents 2,367
No answer/excluded 274
Response Rate 89.6%
Comparison Data %
Concordance: Yes v No 151 / 214 70.5%
Summary of Responses
Yes
62%
No
38%
Yes
70%
No
30%
Yes
62%
No
38%
Self-Reported
Initiative States
N=1,240 in 18 states
Other States with
Identified Initiative
N=571 in 14 states
Non-
Initiative States
N=556 in 19 states
< 45%
45% – 65%
65% – 80%
> 80%
Yes
66%
No
34%
“Not Done” 53%
% Hospitals Reported Yes-Policy
“Not Done” 63% “Not Done” 49% “Not Done” 41%