REDUCING INFANT MORTALITY THROUGH PERINATAL PERIODS OF RISK (PPOR) OPHA Conference September 27, 2016
Objectives • Infant Mortality Awareness Month • Fetal & Infant Mortality Review process • Perinatal Periods of Risk (PPOR) • Potential areas of impact
Infant Mortality Awareness Month • Nationally recognized Passed by House of Representatives in 2006 • • IMR declined 13% between 2005-2013 1 • We still have work to do… U.S. Ranks 25 th out of 29 industrialized countries for • infant mortality 1 Enough infant deaths occurred in 2014 to fill 1,000 • kindergarten classrooms 2 >$26 billion spent due to preterm labor 3 • 1. cdc/gov/nchs/data/hus/hus15.pdf 2. cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf 3. hrsa.gov/advisorycommittees/mchbadvisory/infantmortality/correspondence/recommendations2013.pdf
Who We Are Mission: Tulsa’s Fetal & Infant Mortality Review (TFIMR) project is designed to enhance the health and well-being of women, infants and families. By studying recent fetal and infant deaths occurring in our community, we are able to identify trends and explore ways to reduce fetal and infant mortality. Goal: Our goal is to bring community members together to examine social, economic, cultural, safety, and health system factors associated with fetal and infant death. Through TFIMR, the community becomes experts in planning locally appropriate policies and specific interventions to better serve families and the community as a whole.
What We Do • Examines significant medical, social, economic, cultural, safety, and health system factors that are associated with fetal/infant mortality through review of individual cases. • Plans a series of interventions and policies to address these factors to improve service systems and community resources. • Participates in the implementation of community-based interventions and policies. • Assesses the progress of these interventions and the long-term impact on reducing mortality.
Basic Steps of the FIMR Process • Death certificate information is received from OSDH. • Vital information pertaining to the infant’s death is abstracted and a home interview is completed with the family. • The abstracted information is de-identified and put into the case review format for presentation to the Case Review Team (CRT). • Cases are reviewed. • Recommendations for change are given by the CRT. • These recommendations are communicated to the Community Action Team (CAT). • CAT develops and implements interventions for systemic change based upon the recommendations.
Case Criteria Infant Fetal • Infant <365 days old • Demise occurred >19 weeks gestation • Born in one of TFIMR counties • Delivered in one of TFIMR counties • Died in one of TFIMR counties • Mother received prenatal care in one of TFIMR counties • Mother received prenatal care in one of TFIMR counties • Not the result of an elective termination • Manner of death is natural • Accidental and unknown manner of deaths are eligible if related to unsafe sleeping environments
What is PPOR? • Provides a framework and tools to investigate and prevent excess fetal and infant mortality • Designed for use by US urban communities to better address local challenges of fetal and infant mortality • Adapted in part from Periods of Risk (POR) approach developed by Dr. Brian McCarthy and colleagues at the World Health Organization (WHO)
PPOR Stages • There are six stages of PPOR • THD is currently finishing Phase 1 analysis of Stage 2
Matrix Tool Initial analysis divides fetal and infant deaths into four perinatal periods of risk based on birth weight and age at death
Potential Actions The periods of risk are useful because causes of death tend to be similar within in each and allows for efforts to be more focused on periods with excess gaps
Population Analyzed • Creek County • Rogers County • Okmulgee County • Tulsa County • Osage County • Wagoner County • Pawnee County • Washington County
Required Data for Analysis Primary Vital Records 1. Linked Birth and Infant Death Certificates 2. Live Birth Certificates 3. Fetal Death Certificates
Reference Population • Population of real mothers with near-optimal birth outcomes • Provides a realistic benchmark Reference Population Criteria Maternal Health / Prematurity White/Caucasian 1.9 Non-Hispanic Maternal Care Newborn Care Infant Health Twenty-five years of age and older 1.4 0.8 0.8 Associate’s Degree and higher Resided in one of the eight counties analyzed at the time of delivery
PPOR Calculations All Eight Counties Reference Population Maternal Health / Prematurity Maternal Health / Prematurity 3.5 1.9 - Maternal Care Newborn Care Infant Health Maternal Care Newborn Care Infant Health 2.0 1.5 2.4 1.4 0.8 0.8 Excess Deaths Maternal Health / Prematurity 1.6 = Maternal Care Newborn Care Infant Health 0.5 0.7 1.7
PPOR Calculation by Race: White/Caucasian White/Caucasian Reference Population Maternal Health / Prematurity Maternal Health / Prematurity 3.0 1.9 - Maternal Care Newborn Care Infant Health Maternal Care Newborn Care Infant Health 1.7 1.2 2.2 1.4 0.8 0.8 Excess Deaths Maternal Health / Prematurity 1.1 = Maternal Care Newborn Care Infant Health 0.3 0.4 1.4
PPOR Calculations by Race: Black/African American Black/African American Reference Population Maternal Health / Prematurity Maternal Health / Prematurity 7.1 1.9 - Maternal Care Newborn Care Infant Health Maternal Care Newborn Care Infant Health 3.7 3.3 1.4 0.8 0.8 *Data not available Excess Deaths Maternal Health / Prematurity 5.3 = Maternal Care Newborn Care Infant Health 2.2 2.6 *Data not available
PPOR Calculations by Race: American Indian/Alaska Native American Indian/Alaska Native Reference Population Maternal Health / Prematurity Maternal Health / Prematurity 2.7 1.9 - Maternal Care Newborn Care Infant Health Maternal Care Newborn Care Infant Health 1.7 2.7 2.7 1.4 0.8 0.8 Excess Deaths Maternal Health / Prematurity 0.8 = Maternal Care Newborn Care Infant Health 0.3 1.9 1.9
PPOR Calculations by Race: Excess Deaths White/Caucasian Black/African American Maternal Health / Prematurity Maternal Health / Prematurity 1.1 5.3 Maternal Care Newborn Care Infant Health Maternal Care Newborn Care Infant Health 0.3 0.4 1.4 2.2 2.6 *Data not available American Indian/Alaska Native Maternal Health / Prematurity 0.8 Maternal Care Newborn Care Infant Health 0.3 1.9 1.9
PPOR by County Tulsa County Maternal Health / Prematurity 3.5 Remaining Seven Counties Maternal Care Newborn Care Infant Health 1.9 1.4 2.4 Maternal Health / Prematurity 3.3 Maternal Care Newborn Care Infant Health 2.1 1.8 2.4
Moving Forward… • Phase 1 PPOR analysis Expand birth cohort to include 2014 • births Further investigation for • subpopulations • Phase 2 PPOR analysis – further epidemiologic investigation Build on information discovered in • Phase 1
Next Steps Phase 2 Analyses: Further Epidemiologic Investigation • Explains why the excess deaths occurred and directs prevention efforts • Systematically investigate opportunity gaps Identify pathways and mechanisms that are attributed to excess fetal and • infant mortality Identify risk and preventative factors and measure their presence within our • population Estimate potential impact of identified factors • More information to direct community prevention planning •
Additional Data Sources • Fetal & Infant Mortality Review (FIMR) Case Review • • Pregnancy Risk Assessment Monitoring System (PRAMS) • Program Administrative Data
Prevention Strategies • Community Stakeholder Involvement • Data-Driven Decision Making • Targeted Prevention Efforts
Jacksonville, FL – Duvall County Strategy • Magnolia Project Addressed gap in women’s health care • Preconception health movement • Limitations: Individual intervention, “boomerang” effect • • Life Course Case Management Model Crisis stabilization • Life Plan • • Access to preventative health care, family & community support, reduction of poverty and social inequity
Questions? THANK YOU! Funding for TFIMR is provided in part by the Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Title V Block Grant CFDA# 93.994, Grant No. B04MC07824
Contact Us Kayla Robison, MS Rachel Erkenbeck-Hart, MPH Data Abstractor MCH Epidemiologist krobison@Tulsa-health.org rhart@Tulsa-health.org 918.595.4464 918.595.4463 Susan Hurtado, BSW Sandra Braun, MPH Community Specialist MCH Epidemiologist shurtado@Tulsa-health.org sbraun@Tulsa-health.org 918.595.4474 918.595.4428 For more information visit: www.ok.gov/health/Community_&_Family_Health/Improving_Infant_Outcomes/index.html
Recommend
More recommend
