The Journey to LOCATe Levels of Neonatal & Maternal Care

Posted August 04, 2016 by Josh Grant

Doctor Handling Paperwork
Surveying healthcare providers allows the CDC to assess levels of neonatal and maternal care around the country. 
The Centers for Disease Control and Prevention’s (CDC) Levels of Care Assessment Tool (LOCATe) is assisting states and jurisdictions by assessing neonatal and maternal levels of care in their birthing facilities. This assessment creates opportunities for conversations among stakeholders to discuss risk-appropriate care, a strategy to reduce infant mortality and improve maternal and child health outcomes.   

“Having hospitals complete surveys and examine their current care systems allows states to see where there are gaps in care and how they can start thinking about improvement efforts,” says Zandra Levesque, MPH, a senior project manager at NICHQ. “This is an important strategy for states participating in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) seeking to improve infant health outcomes.” 

LOCATe is based on guidelines and policy statements issued by the American Academy of Pediatrics, American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine. It is a simple survey tool that produces standardized assessments of the neonatal and maternal levels of care delivered across facilities. Data collection typically takes states two months.
Currently 10 states have implemented LOCATe. Some states, are merging the LOCATe data with birth and infant death vital records data leading to a more robust analysis. 

“Combining the LOCATe data with vital records data allows us to look at how facility-level mortality rates vary by volume of services and equipment availability,” says Andrea Catalano, a member of the Maternal Child Health (MCH) Epidemiology team in the CDC’s Division of Reproductive Health. “There is really a lot you can do if you want to merge the data with existing data that states have.”

Since being tested in the field by several states, there have been multiple iterations of the tool and the CDC team is currently working on version 6. These edits have resulted in a tool that is in alignment with the guidelines and policy statements while continuing to minimize the burden for respondents. In Illinois, the state is considering how the current regionalized perinatal system compares to the newest guidelines for neonatal and maternal levels of care. They are using LOCATe to understand how the system could be improved, including whether to add maternal levels to the state designation system and exploring to what extent neonatal levels of care resource requirements should be changed.

“There are real implications for changing the way that our systems are designed, including payment structures and services we incentivize,” says Amanda Bennett, PhD, a CDC MCH epidemiology assignee placed in the Illinois Department of Public Health. “These are important decisions that have a long-term impact on the health of mothers and babies and LOCATe data are helping to inform these decisions.”

Meanwhile in Wyoming, the state used LOCATe to learn more about its facilities and their capabilities to deliver risk appropriate care. Using direct contact instead of mass communications, the team developed working relationships with hospitals and encouraged them to finish the survey. 

“When we had a few facilities that had not completed LOCATe, personal reminders from workgroup members directly to the hospitals were extremely helpful,” said Ashley Busacker, PhD, a CDC MCH epidemiologist in the Wyoming Department of Health. The data will help the Wyoming Department of Health learn about the capabilities of Wyoming hospitals. There’s also an effort to work with neighboring states where Wyoming residents go for care, because Wyoming does not have a Level 3 facility. 

The findings gleaned from LOCATe allow states to look into specific levels of care and understand the distribution of resources, personnel, and services throughout the state. The data are a starting point for discussions about possible improvements and changes that could help lead to optimal maternal and child healthcare in the future.

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