payers, policy-makers, patients and families. TIOP III is filled with examples of promising and successful initiatives at hospitals and health care systems across the country, designed to improve the quality of perinatal care. • Assuring the uptake of robust perinatal quality improvement and safety initiatives • Creating equity and decreasing disparities in perinatal care and outcomes • Empowering women and families with information to enable the development of full partnerships between health care providers and patients and shared decision-making in perinatal care • Standardizing the regionalization of perinatal services • Strengthening the national vital statistics system Summary of TIOP III Cross-Cutting Themes Andrea Kott and Scott D. Berns continued x marchofdimes.com Toward Improving the Outcome of Pregnancy III Ultimately, reaching a more efficient, more accountable system of perinatal care will require a level of collaboration, services integration and communication that lead to successful perinatal quality improvement initiatives, many of which are described throughout this book. In addition to the consistent collection of data and measurement and the application of evidence-based interventions, successful collaborations, like all perinatal quality improvement, depend on the engagement, support and commitment of everyone reading this book: health care professionals and hospital leadership, public health professionals and community-based service providers, research scientists, policymakers and payers, as well as patients and families. TIOP III is the call to action and the tool that can inspire and guide their efforts toward improving the outcome of pregnancy. Executive Summary Toward Improving the Outcome of Pregnancy III marchofdimes.com xi TIOP I also galvanized the March of Dimes leadership to intensify its support for neonatal research, regional neonatal intensive care unit (NICU) centers, neonatal nursing education, intensive care nurseries, nursemidwife education, community health teams and genetic counseling. Subsequently, through research breakthroughs such as surfactant therapy, continued development of lifesaving NICU technology and improved systems accomplished through regionalization, infant mortality has continued a steady decline to the present day. Nevertheless, maternal health issues such as lack of health insurance, poverty, substance abuse, unintended pregnancy and other behavioral and social barriers continued to hamper the Foundation’s efforts to improve birth outcomes. As a result, the Foundation turned its attention to improving care during pregnancy and birth through proven risk-reduction strategies and the establishment of perinatal boards, to better ensure accountability within regionalized systems of care. This became the framework for TIOP II, Toward Improving the Outcome of Pregnancy: The 90s and Beyond, which a second Committee on Perinatal Health issued in 1993. The March of Dimes put TIOP II to work at the grassroots level through the Campaign for Healthier Babies, a 1990 initiative that addressed improved access to prenatal care and, Think Ahead!, in 1995, a nationwide campaign that emphasized preconception care, healthy lifestyles and the importance of folic acid. Both the 1972 and 1990 Committees on Perinatal Health aimed to reduce rates of maternal and infant mortality and morbidity in the United States. But one negative birth outcome began to receive increased scrutiny within the Foundation, and that was the relentless increase in the nation’s rate of premature birth since TIOP I. The March of Dimes responded to this alarming trend by launching a comprehensive national Prematurity Campaign in 2003. The Foundation has since attacked the issue of premature birth by raising political and public visibility for this problem, supporting cutting-edge research and exploring clinical, educational and public health interventions designed to achieve the widest impact. These include the March of Foreword Toward Improving the Outcome of Pregnancy III has an illustrious past. It began in 1972, when the March of Dimes, newly dedicated to the burgeoning field of perinatology, created the Committee on Perinatal Health and asked it to identify critical issues and develop guidelines and recommendations for the care of pregnant women and newborns with a special focus on infant mortality. Just four years later, in 1976, the committee released Toward Improving The Outcome of Pregnancy (TIOP I), a book that synthesized the efforts of four organizations (The American College of Obstetricians and Gynecologists, the American Medical Association, the American Academy of Pediatrics, and the American Academy of Family Physicians) and revolutionized the system of perinatal hospital care by recommending systematized, cohesive regional networks of hospitals, each assigned to one of three levels of inpatient care based on patient risks and needs. xii marchofdimes.com Toward Improving the Outcome of Pregnancy III Dimes NICU Family Support® program and “Healthy Babies Are Worth the Wait®”, a prematurity-prevention partnership in Kentucky. Preliminary data from the National Center for Health Statistics show that for the first time in 30 years, rates of premature birth have declined in 2007 as well as 2008, most