AMERICAN JOURNAL OF MANAGED CARE: Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History

The American Journal of Managed Care (AJMC), which delivers direct access and engagement of professional audiences by providing multichannel sources of trusted health care and scientific information, has published a peer review articled about a preterm birth prevention program pioneered by PCCI, Parkland and the Parkland Community Health Plan.

The article, titled “Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History,” examines how Parkland, PCCI and PCHP experts developed a novel prediction model that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

To read the article in a PDF form, go to:

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D CEO Healthcare: Avoiding Pre-Term Birth with Text Messages

D CEO Healthcare features PCCI’s work with the Parkland Community Health Plan and Parkland Hospital on pre-term birth prevention. The results of this work show how PCCI and Parkland are working together to develop innovative ways to improve healthcare for the under-served in our community.


Avoiding Pre-Term Birth with Text Messages in Dallas

At the Parkland Center for Clinical Innovation, data analytics and technology are improving outcomes for underserved pregnant women in Dallas. One significant way to reduce maternal and infant mortality is to avoid pre-term birth, and in 2017, Texas had a 10.4 percent pre-term birth rate – earning a D in the annual ranking from March of Dimes.

The women were enrolled in the Parkland health plan, which reached out to them to get the women signed up for the texting system. Pre-term birth can be a difficult thing to predict, says Dr. Joseph Chang, Associate Chief Medical Officer for Outpatient and Ambulatory Services at Parkland. Traditionally, the only way to know if a women was going to have a pre-term birth was if she had a past pre-term birth. But he says that a couple of interventions, including progesterone shots, can make a huge difference.

“Adherence to medicine is the biggest factor,” Chang says. “If we really were able to identify the right people, use a platform for today’s young parents, maybe that would really work.”

Because Parkland is both the health plan and the healthcare provider, PCCI was able to access both sides of the payer relationship in a way that can be difficult to access in traditional healthcare systems. Their system brought the electronic health record together with behavioral health information to identify the women, and yielded impressive results.

Appointments were closely monitored, with PCCI measuring data along the way to adjust the text messaging and tailor it to the patients’ needs. After just one year, women in the program increased prenatal visit attendance by 24 percent, reduced pre-term birth by 27 percent. The program also reduced post-delivery cost by 54 percent in the first year.  The 679 women who enrolled saved the system $1 million in the first year.

Fighting healthcare battles before the patient arrives at the doctor is important for PCCI CEO Steve Miff. “Health begins where we work, live, learn, play, and pray,” he says. “We are moving upstream, because if they are not addressed it will have a negative impact on health.”

Politico covered PCCI’s efforts to reduce frequent flyers by targeting patients who lacked many of the supports needed after they left the hospital. Their software connected social service agencies to the healthcare system to refer patients to get those services outside of the hospital, which would be cheaper and more efficient than seeing patients return again and again because they lacked food or housing. The impact was significant. The pre-term birth program is another way to head off medical costs before they happen.

Looking ahead, PCCI hopes to continue to fight social isolation to provide access to services, improving many of the behavioral and environmental factors that negatively impact health. “How do we use digital tech and bring women together, create clusters of similar individuals, customize behavioral therapy?” Miff says. “We can do that via a digitally provided environment, we can do it from home, and bridge the gap via telemedicine.”

Chang sees this technology being applied to any number of ailments, but sees a massive opportunity in addressing diabetes treatment. There are apps for measuring and taking glucose, but the texting might be more effective because it doesn’t require another application. “The biggest problem is taking their medicine – taking it and taking it correctly.”

Parkland RITE program targets prevention of hospital infections and improved sepsis care

Hospital-wide effort reduces infection rates, saves lives

DALLAS —Each year sepsis strikes approximately 1.7 million people in the U.S. and more than a quarter million die from the condition, making it a major cause of death. Healthcare-associated infections (HAI) contribute to about 25 percent of these deaths. According to infection prevention experts, many hospitals are trying different approaches to reduce healthcare-associated infections, improve care of patients presenting with sepsis, and save lives. In 2013, Parkland Health & Hospital System launched an innovative hospital-wide program to reduce HAI and sepsis-related deaths, called RITE (Reduce Infections Together in Everyone).

In the first five years, the multi-disciplinary program has achieved impressive results, reducing rates of infection each year since the program was launched. The net estimated impact of the RITE program is more than a thousand infections prevented and approximately $17,781,000 in cost avoidance.

“Providing quality care begins with providing safe care,” said Parkland’s Chief of Infection Prevention, Pranavi Sreeramoju, MD. “We targeted catheter-associated urinary tract infections and central line-associated blood stream infections hospital-wide, surgical site infections following eighteen different types of surgical procedures, and patients presenting with signs and symptoms of sepsis to our emergency department.”

Parkland’s prevention approach centered on standardizing care of patients at risk for these complications; engaging healthcare personnel by talking to them and exploring barriers to adoption of best practice; standardizing curriculum on how to prevent HAI and improve sepsis care; use of medical informatics tools such as early warning system for sepsis developed by Parkland Center for Clinical Innovation; use of best practice alerts and order sets in the electronic medical records; and improving workflows.

According to Dr. Sreeramoju who is also Associate Professor of Internal Medicine at UT Southwestern Medical Center, Parkland’s RITE initiative forged a new approach to prevention by leaning on one part medical science and two parts social science.

“It’s been said about infection prevention that we know what to do – that’s the medical science. The biggest challenge for hospitals remains getting everyone to do the right thing, all the time,” she said. “Something as basic as hand hygiene requires constant vigilance in a hospital setting. So we decided to focus on identifying the most effective ways to influence behavior and make best practices easier to adhere to.

“We took a ‘high touch’ approach to working with staff, spending time analyzing interactions among multi-disciplinary caregivers, and we gave front-line staff the opportunity to provide input that could help us improve our infection prevention strategies,” Dr. Sreeramoju explained.

The scope of the RITE initiative is massive. Parkland Memorial Hospital has more than 40,000 inpatient discharges and 244,000 emergency department visits annually. Approximately 2,500 patients present to Parkland’s ED with suspected sepsis each year.

During Sepsis Awareness Month in September, organizations like the Sepsis Alliance, one of the nation’s leading sepsis patient advocacy groups, hope to increase public and healthcare professionals’ knowledge about this dangerous and vexing health risk. In a 2016 report, the Sepsis Alliance stated that “even though hospitalizations are increasing, a majority of Americans still don’t know what sepsis is or how to treat it.” The most recent Sepsis Alliance Awareness Survey found that less than one-half of all adult Americans have ever heard of sepsis. And the number is even lower among younger adults.

To learn more about services at Parkland hospital, visit


Parkland Health & Hospital System
Catherine Bradley

Mike Crouch