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Initiative: Premature Infant Hospital Discharge and Quality Improvement

Model Legislative Language

Note: Text in blue must be customized for your state. See endnotes for sources.

Section 1. Purpose.

It is the purpose of this Act to:

  1. Improve healthcare quality and outcomes for infants born preterm through enhanced hospital discharge, follow-up care and management processes and reduced re-hospitalization from infectious disease and other complications.
  2. Reduce infant morbidity and mortality associated with prematurity.

Section 2. Findings.

The General Assembly finds that:

  1. Infants born premature at less than 37 weeks gestational age have greater morbidity and mortality than full-term infants.
  2. In 2006, 12.8 percent of all births in the United States were premature, accounting for more than 542,000 infants.
  3. In [state], [1] in [8] babies were born premature in 2006, or [13.3]% of live births, accounting for [23,955] premature births.1
  4. Between 1996 and 2006, the rate of infants born premature in [state] increased nearly [15]%.2
  5. The rate of premature birth in [state] is highest in African American infants (19.3%), followed by Native Americans (15.6%), Hispanics (12.1%) and Caucasians (11.9%).3
  6. Approximately 70% of premature births occur in the late preterm period between 34 and 36 completed weeks of gestation, and late-preterm babies have significant differences in clinical outcomes than full-term infants including greater risk for temperature instability, hypoglycemia, respiratory distress, and jaundice.
  7. In 2005, preterm birth cost the United States at least $26.2 billion, or $51,600 for every infant born prematurely.
  8. Medical costs for premature babies are greater than they are for healthy newborns. In 2007, the average medical costs for a preterm baby were more than 10 times as high as they were for a healthy full-term baby. The costs for a healthy baby from birth to his first birthday were $4,551. For a preterm baby, the costs were $49,033.
  9. The costs of premature birth to [state] may be significant because the state Medicaid program paid for [40]% of all births in 2003. 4
  10. Premature infant standard of care practices of clinicians and hospitals may vary across the state, particularly for late preterm births.
  11. There are no standardized procedures for hospital discharge and follow-up care of premature infants, and as a result, babies born premature may leave the hospital after birth without adequate discharge and follow-up care plans in place to ensure they receive appropriate care to address their special health needs once they are home in their community.
  12. Without organized discharge care plans, premature babies are more likely to experience gaps in healthcare and medical complications including re-hospitalization.
  13. The most frequent causes of re-hospitalization for premature infants are RSV bronchiolitis, bronchiolitis (cause unspecified), pneumonia (cause unspecified), esophageal reflux and vascular implant complications.
  14. Because all premature infants, and especially late-preterm infants born at 34 through 36 weeks gestational age, have higher risks for medical complications and re-hospitalizations compared to full-term infants, the State should examine and improve healthcare interventions for premature infants to measurably improve their outcomes within their first year of life.

Section 3. Goals.

A. The state medical assistance program [and children’s health insurance program], in consultation with statewide organizations focused on premature infant healthcare, shall:

  1. Examine and improve hospital discharge and follow-up care procedures for premature infants born less than 37 weeks gestational age to ensure standardized and coordinated processes are followed as premature infants leave the hospital from either a Level 1 (well baby nursery), Level 2 (step down or transitional nursery) or Level 3 (neonatal intensive care unit) unit and transition to follow-up care by a healthcare or homecare provider in the community.
  2. Encourage hospitals serving infants eligible for medical assistance and child health assistance to report to the state the causes and incidence of all re-hospitalizations of infants born premature at less than 37 weeks gestational age within their first six months of life.
  3. Utilize guidance, if available, from the Centers for Medicare and Medicaid Services’ Neonatal Outcomes Improvement Project to implement programs to improve newborn outcomes, reduce newborn health costs and establish ongoing quality improvement for newborns, including hospital discharge and follow-up care.

B. The state medical assistance program [and children’s health insurance program] shall submit an annual report to the General Assembly by [insert date] of each year that provides information about:

  1. the programs progress in implementing the provisions of this section;
  2. the incidence and causes of re-hospitalizations of infants born premature at less than 37 weeks gestational age within their first six months of life; and
  3. recommendations to improve newborn outcomes and ensure ongoing health quality improvement, including technological needs to improve surveillance of premature infants as they are discharged from the hospital and transition to a healthcare provider in the community.
  1. Find data for your state at: http://www.marchofdimes.com/peristats/
  2. Find data for your state at: http://statehealthfacts.org/comparetable.jsp?ind=223&cat=4&sub=57&yr=58&typ=2&sort=a