In January 2011, University Medical Center (UMC) of El Paso joined the March of Dimes Big 5 initiative, which aimed to reduce early elective deliveries (EEDs) in California, Florida, Illinois, New York, and Texas. The five states together account for roughly 40 percent of U.S. births annually.
After participating in the collaborative, UMC — which delivers about one-third of babies born in El Paso — reduced its EED rate from 27 percent to 0 percent, becoming the first hospital in the city to eliminate EEDs.
Using the March of Dimes’ 39 weeks toolkit, UMC implemented a hard-stop policy against non-medically indicated deliveries before 39 weeks gestation. While some patients and physicians resisted the change because they were accustomed to the established norm and convenience of “social inductions,” two physicians and the hospital’s administration championed the policy. In addition, physicians who refused to adhere to the new policy were barred from practicing at UMC.
The hospital also used materials from the 39 weeks toolkit to educate hospital staff and patients about the dangers of EEDs, increasing policy adherence and decreasing demand from patients. About 90 percent of UMC patients are Hispanic/Latino and 77 percent are recipients of Medicaid or are uninsured.
According to UMC, administration, physician and community alignment was critical to effectively implementing the EED policy. Between its education and community outreach programs, UMC has set an expectation that EEDs are not an option.
Because of its success, other Texas providers took lessons from UMC as they worked to comply with an October 2011 Texas Medicaid policy change that halted hospital reimbursement for EEDs and EED-related neonatal intensive care unit care.