Phoebe: Welcome to Beyond the Data.
I'm Dr. Phoebe Thorpe and here
with me today is Dr. David Lakey.
Thank you for joining us.
David: Thank you Phoebe.
Phoebe: In the session today
for the Public Health Grand Rounds we heard a lot
about preterm birth and about
the social determinants of health
and the impact that they are having with the disparities
in preterm births in the United States and it's clear
that we need some more research
to understand how we can work in that area.
But there is some research about
what we can do about preterm births.
Can you share with us some of the things that you're doing
in Texas, about to reduce preterm birthrates?
David: Absolutely, first, Grand Rounds today was great.
A lot of good data related to the challenge we have
in the United States related to prematurity, infant mortality.
But, also, some specific things that we can do.
In Texas we've taken this very seriously.
We have gotten support from the Texas legislature
to address this issue.
This is one of those issues that affects so many individuals,
families, the babies, but also from a state perspective,
the state of Texas 57% of all the babies are paid
through the Medicaid program and so that got the attention
of the legislature to make this a priority
for the state of Texas.
Not only is it a good thing to do,
you can make a fiscal argument that you can save money
if they decrease the number of babies that end
up in the NICUs across the state.
And so first, you have to make sure it's a priority.
And this is one of those issues that you can,
you can identify several different variables
that you can work on that'll have a significant effect.
So things, simple things like getting women in earlier
to prenatal care, educating young women related
to the effect that smoking can have on prematurity,
that their health is really important, that they need to get
in to see their OB/GYN physician early, and there are medicines
that we can provide to the women
if they've had a premature baby before that'll decrease the
chances that they will have a premature baby again.
So there specific things that we can do
that can attack this issue.
We just have to make it a priority.
Phoebe: And it sounds like in Texas you've done a lot of focus
on those different areas.
One of the things that we heard today was
about the health care system and how it can be both a problem
and a place for improvement.
The problem being early elective deliveries and moving away
from early elective deliveries.
Can you tell us some about what you've been able
to do there with that?
David: Sure.
And again we've made it a priority.
Pregnancy is not comfortable and women want to get it
over as quick as they can.
But, unfortunately
if you deliver a baby before the baby's ready,
the baby is not ready to be here in this world.
Good data that says that if you deliver those babies
prematurely, and do elective deliveries
on the babies before 39 weeks.
Of that, large numbers end up in the NICUs
and that becomes very costly.
And so costly not only on the conditions for the baby,
that the lungs aren't developed, the brain's not developed,
but also cost a lot of money.
And so what we've done in Texas, I think a lot
of states have done, is made it a priority.
And so our Texas legislature directed our Medicaid program
to say we know what the data is.
We shouldn't be allowing that, so to speak,
by paying for early elective deliveries and bad practice.
So we decided that we wouldn't pay
for those early elective deliveries before 39 weeks.
We also complimented that with education.
So you have to educate mom and grandmother why it's
so important that they be delivered,
be delivered after 39 weeks.
Education of the physicians, physicians want
to do the right thing but sometimes they're put
under pressure to deliver that baby too early.
And so, educating them on why it's so important
and then feeding data back to the hospitals
to let them know what their rates are
and the consequences of that.
It's a multipronged approach to making sure
that the women know what the issue is, their family knows,
the providers know, working in that whole context
to make it a priority.
Phoebe: That's a very interesting idea
because I hear you...
I know you have a lot of interest in systems work
and I hear you kind of really bringing that into,
into addressing the problem where it's much more complex
and related to many different factors.
But you're bringing the whole, looking at the whole,
I used the word system as in like the whole problem
and all the different areas that interacts with the,
with how to prevent preterm birth.
So what about the progesterone?
I know that that also is effective
at preventing preterm birth.
Have you had some work and success there?
David: Yes we have.
We haven't solved the problem yet but we've elevated it
and we put attention on it.
Since there's good data that if a woman has had a premature baby
before, that if you give her this medicine,
progesterone 17-hydroxy progesterone, but you have
to give it early enough that you can prevent the chances
of a second premature baby by over 30%.
So, the challenge there is to make sure we get the women
in early enough so we get them in that window of opportunity
and that their physicians know
that she's had a premature baby before.
And so a lot of work working across systems
if you don't solve this problem you have to get
out of our comfort zone and work with other types of programs
to figure out how to identify women
and get them the medicine they need so that
that baby has the best chance
to have a healthy, happy first birthday.
Phoebe: Yeah, and I, As you were talking I was also thinking
about not only do you have to get everybody
out of their comfort zone, but I was thinking
about the difficulties that OBs have
and that they want the women to be as healthy
as possible even before they come to them and that kind of
gets to the notion of pari-conception care
or healthcare outside of the pregnancy.
Are there areas that you've been working in Texas on that?
David: I think you're exactly right.
So one of the lessons that I've learned from talking
to OB/GYN physicians is they have a limited time
with that young lady, and if the young lady comes in
and she's smoking several packs a day, and is overweight,
maybe using substances, that they really don't have
that much time to address all those issues before the baby is
going to be delivered.
And so we need to move upstream
and address those issues beforehand.
And so we developed a program
in our state called, "Someday Starts Now".
And the premise of that is that if you want
to have a healthy delivery five years, 10 years, someday,
that that someday starts now.
So we need to get into shape.
Do the things we need to do today to have
that healthy baby five years from now.
Phoebe: Wow, that's a really forward thinking program
that you are championing.
I really appreciate that.
Are there other areas you think are important that we address?
David: Well, one of the things that really stood
out to me today during Grand Rounds are the things we call,
the social determinants of health.
That there are things that occur in our society
that really have a huge impact on the ability
to have a healthy baby.
We heard today the rates of infant mortality being twice
as high in the African-American population.
You know that's consistent with what we see in Texas, you know,
education is really important, and poverty is very important,
those things go hand-in-hand with ethnicity in many
of our states and so we have to make sure that we look
at this issue through that lens
of the social determinants of health.
How do we really address the health needs of the community?
Predominately African-American communities
across the United States.
Give them the support that we need in order
to maximize the chance that, we can address that, you know,
unacceptable rate of infant mortality
in the African-American community.
Phoebe: Yeah, very shocking to hear that, it was for me too.
Thank you very much for joining us.
David Well, thank you, it's been a privilege.
Phoebe: Appreciate it.
And thank you for joining us
and see you next time for Beyond the Data.