Monday, November 19, 2012

March of Dimes Says the PREEMIE Act Saves Lives. Does It?

Saving children's lives. Nothing could be nobler right?

According to a November 15 March of Dimes press release:

The PREEMIE Reauthorization Act will save infants’ lives," said Dr. Jennifer L. Howse, President of the March of Dimes. “Tonight the Senate took a vital step toward ensuring a healthy start for our nation’s infants."

The release goes on to say:

Our efforts are bearing fruit,” Dr. Howse added. “Preterm birth rates have now dropped for five consecutive years after rising steadily for three decades. The PREEMIE Reauthorization Act will continue to fuel our progress by supporting federal research and promoting known interventions and community initiatives."

"Really?" asks the Disease Management Care Blog.  What about the dozens of lecturers, professors and colleagues that have told the DMCB that preterm birth rates have remained stubbornly unchanged for decades? 

It's a significant problem because the delivery of a child prior to 37 weeks gestation (vs. the usual 39 weeks) is associated with many complications for both the mother and child.

Wanting to learn more about this life-saving legislative miracle courtesy of Uncle Sam, the DMCB decided to take a look for itself.

It turns out the original "Prematurity Research Expansion and Education for Mothers who deliver Infants Early Act" (or PREEMIE) Act was passed and signed into law by then President Bush in 2006.  The statute provided for a number of interventions, including millions of dollars worth of research funding, provider education and nationwide monitoring. The funding was due to run out in 2011. 

Enter the PREEMIE Reauthorization Act that was just passed by the U.S. Senate.  It doesn't appear to authorize any funding, but it essentially continues the activities contained in the original 2006 legislation by striking out the term "2011" and replacing it with "2017."

Based on the March of Dimes press release quotes above, it appears that the organization is crediting the 2006 PREEMIE with the nationwide drop in preterm birth rates. The basis for this is March of Dimes data that can be found here. If you look at the upper right hand corner, you can see that the prematurity rate went from 12.8% in 2006 (when the law was passed) to a preliminary measure of 11.7% in 2011.

Unfortunately, these data do not tell the entire story. For that, the DMCB went to the "" website and discovered that overall prematurity rates have remained stubbornly fixed in the 10.6% to 12.8% range for over two decades.  The rate peaked in 2006 and has been drifting back down to the baseline historical average.   To the DMCB it looks like normal year-to-year variation.  What's more, DMCB readers are well aware of the phenomenon of regression to the mean.

Next step for PREEMIE is the House of Representatives.  The DMCB isn't advocating for or against PREEMIE, but it hopes a second look in our bicameral legislative process prompts a more rigorous and complete examination of the outcomes associated with this piece of legislation.

Editorial Comment: The DMCB is all for research to discover what works, but it would like to point out that there is a considerable body of published literature on the topic.  Do we really need more research, or do we need to figure out how to provide these services using the principles of population health management? 

You be the judge: it's your money.  

Image from Wikipedia.

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