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The network-wide quality-improvement activities by the Canadian neonate network and their EPIQ process has created new and important knowledge for the treatment of our smallest and most 'delicate' patients. The Plan-Do-Study-Act cycles have been important to the facilitation of quality improvement.
Maternity providers have become involved in the EPIQ process with delivery directed practices to enhance preterm neonates physiology as reported antenatal steroids at appropriate times and doses but are adding new considerations such as delayed cord clamping through the associated Maternal Fetal Medicine Network.
The overall message for this respond is that more priority and direction of clinical and research funding needs to be directed to the 'beginning of life' by federal and provincial administrations. In addition to supporting the EPIQ neonatal treatment successes, there needs to be more clinical support and research activity for team-based multi-focused prevention of preterm birth. Clinical care priority setting calculations such as that used in the Oregon Health Care model highlight ranking the order of health categories (100 to 1) X additive impact on healthy life years, impact on suffering, population effects, vulnerable of population affected, tertiary prevention X effectiveness X need for service. Using this type of prioritization ranking results in pregnancy, pediatrics, mental health, and chronic disease management being placed at high priority.
The use of better metrics to determine health care funding priority is required as the cost of health care increases in the 14 separate healthcare authorities in Canada.