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Preterm Birth: Causes, Consequences, and Prevention Section V Research and Policy RECOMMENDATIONS Recommendation V-1: The National Institutes of Health and private foundations should establish integrated multidisciplinary research centers. The objective of these centers will be to focus on understanding the causes of preterm birth and the health outcomes for women and their infants who were born preterm. Consistent with the Roadmap initiative of the National Institutes of Health, these activities should include the following: Basic, translational, and clinical research involving the clinical, basic, and behavioral and social science disciplines is needed. This research should include but not be limited to investigations covered by recommendations pertaining to the etiologies of preterm birth; the psychosocial, behavioral, sociodemographic, and environmental toxicant exposure-related risk factors associated with preterm birth; the disparities in the rates of preterm birth by race and ethnicity; the identification and treatment of women at risk of preterm labor; quality of health care provided to infants born preterm; and health services research. Sustained intellectual leadership of these research activities is essential to make progress in understanding and improving the outcomes for women and their infants who have been born preterm.
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Preterm Birth: Causes, Consequences, and Prevention Mentored research training programs should be integral parts of these centers. Fostering the development of basic and clinical researchers, including facilitating opportunities for funding and promotion, is critical. Funding agencies should provide ample and sustained funds to allow these centers to investigate the complex syndrome of preterm birth, analogous to programs developed to study cancer and cardiovascular disease. Recommendation V-2: Establish a quality agenda. Investigators, professional societies, state agencies, payors, and funding agencies should establish a quality agenda with the intent of maximizing outcomes with current technology for infants born preterm. This agenda should define quality across the full spectrum of providers who treat women delivering preterm and infants born preterm; identify efficacious interventions for preterm infants and identify the quality improvement efforts that are needed to incorporate these interventions into practice; and analyze variations in outcomes for preterm infants among institutions. Recommendation V-3: Conduct research to understand the impact of the health care delivery system on preterm birth. The National Institutes of Health, the Agency for Healthcare Quality and Research, and private foundations should conduct and support research to understand the consequences of the organization and financing of the health care delivery system on access, quality, cost, and the outcomes of care as they relate to preterm birth throughout the full reproductive and childhood spectrum. Recommendation V-4: Study the effects of public programs and policies on preterm birth. The National Institutes of Health, the Centers for Medicare and Medicaid Services, and private foundations should conduct and/or support research on the role of social programs and policies on the occurrence of preterm birth and the health of children born preterm. Recommendation V-5: Conduct research that will inform public policy. In order to formulate effective public policies to reduce preterm birth and assure healthy outcomes for infants, public and private funding agencies and organizations, state agencies, payors, professional societies, and researchers will need to work to imple-
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Preterm Birth: Causes, Consequences, and Prevention ment all of the previous recommendations. Research in the areas of better defining the problem of preterm birth, clinical investigations, and etiologic and epidemiologic investigations is critical to conduct before policy makers can create policies that will successfully address this problem.
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