COLLABORATIVE IMPROVEMENT & INNOVATION NETWORK (COIIN) TO REDUCE INFANT MORTALITY IN MISSOURI Venkata PS Garikapaty, MSc, MS, PhD, MPH Lead Maternal and Child Health Epidemiologist Missouri Department of Health and Senior Services Email: Venkata.Garikapaty@health.mo.gov FLOURISH Cabinet Meeting, St. Louis City, MO 10/08/2015
OBJECTIVES 2 Infant Mortality in US and Missouri CoIIN Project to Reduce Infant Mortality Missouri CoIIN Priorities Title V MCH Block Grant and CoIIN Priorities
Definition 3 Infant Mortality - death of a baby before his or her first birthday Infant Mortality Rate (IMR) is an estimate of the number of infant deaths for every 1,000 live births Indicator of a nation’s health and well -being INFANT MORTALITY RATE (IMR): Number of resident infant deaths x 1,000 Number of resident live births
IMR’s: Selected Organization for Economic Co-operation and Development Countries, 2010 4 Source: http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf
Percent change in IMR by state: US, 2005-2013 5 Source: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf
MCH Profile – Missouri Missouri Population – 6 million (85% white, 12% AA) Women population – 51% (84% white, 13% AA) 0-19 year old population – 25% (81% white, 16% AA) 34% of women in childbearing age (18-44 years) (82% white, 14% AA) 2014 % Change in number # of Live births % of births from 2003 to 2014 Overall 75,104 100% -2.4% White 59,527 79.3 -6.1% AA 11,628 15.5 5.5% % of Medicaid births = 40% (2014) – 34% whites, 71% AA
Infant Mortality Rates (IMR) : MO and US, 2000-2013 7 MO’s 2014 IMR = 6.1 per 1,000 live births HP 2020: 6.0 per 1,000 Source: MO:DHSS. Vital Statistics; U.S.:CDC, NCHS. National Vital Statistics Reports http://www.cdc.gov/nchs/fastats/infant-health.htm
Leading causes of infant deaths, US and MO, 2013 Source: U.S. data-Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set, http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf ; MO data: DHSS vital statistics mortality files.
IMR by Race, MO and US, 2000-2013 9 MO’s 2014 AA IMR = 11.4 MO’s 2014 White IMR = 5.2 Source: MO data: DHSS. Vital Statistics http://health.mo.gov/data/mica/MICA/ , U.S. data: CDC, National Vital Statistics System, Mortality Tables. http://www.cdc.gov/nchs/nvss/mortality/lcwk7.htm
Infant Mortality Rates by Cause, Region VIII states, 2008-2010 10 2007-11 (MO) Source: Infant Mortality Data Summary Report for Region VII, MCHB / HRSA CoIIN Initiative Meeting, July 2014
Distribution of live births by race : STL County, STL City, and Missouri, 2014 Source: MO:DHSS. Vital Statistics-Birth file
Preterm birth by Race, St. Louis County, St. Louis City, and Missouri - 2014 Source: MO:DHSS. Vital Statistics-Births
Contribution of preterm births to infant mortality rates, 2005-2014 Source: MO:DHSS. Vital Statistics- Linked Birth/Death match file
IMR by race, St. Louis County, St. Louis City, and MO, 2010-2014 Source: MO:DHSS. Vital Statistics-Births
This is where CoIIN comes into play… 15
What is CoIIN? 16 A Collaborative Innovation Network (CoIN) is a team of self- motivated people with a collective vision, enabled by the Web to collaborate in achieving a common goal by sharing ideas, information and work 1 . Key Elements of a CoIN • Being a “cyber - team” (i.e. most CoIN work will be distance-based); • Innovation comes through rapid and on-going communication across all levels; • Work in patterns characterized by meritocracy, transparency, and openness to contributions from everyone. Adapted to reflect focus on both innovation and improvement yielding a Collaborative Improvement & Innovation Network (CoIIN) to Reduce Infant Mortality. Not exclusive to infant mortality – Home Visiting CoIIN, Injury CoIIN 1 Gloor PA. Swarm Creativity: Competitive Advantage through Collaborative Innovation Networks. New York: Oxford University Press, 2006.
Collaborative Improvement & Innovation Network (CoIIN) to Reduce Infant Mortality – History and Vision 17 HRSA / MCHB Initiative, Voluntary Partnership among HRSA, ASTHO, AMCHP , CDC, City Match, CMS, March of Dimes, NGA, NIH and the States National Institute for Children’s Health Quality (NICHQ) – agency responsible for coordinating CoIIN efforts across states, www.nichq.org Began in 13 southern states (Region IV and VI) in January 2012, Region V in March 2013 Lifespan: 12 – 18 months (rapid cycle improvements)
Comm Co mmon St Strategies for Regi gions IV an and VI VI CoIIN Design Increase smoking cessation State te Team ams Stra rate tegy Team ams Enhance Interconception • Title V Directors & • Leads (2-3 Care in Medicaid MCH Staff Content Experts) • State Health • Data & Methods Reduce elective Officials Experts deliveries <39 weeks • Medicaid • MCHB & Partner Directors & Staff Org Staff Enhance perinatal • Other Partners • State regionalization (private, Representatives local/community, consumer) Promote safe sleep Technical ass Te ssistance ce Co Contrac act Team; m; sha hared wo work rkspac ace; da data da dashboard rd
Launch of Missouri CoIIN 19 In 2014, the Infant Mortality (IM) CoIIN was expanded to the remaining 31 states and eight territories including Missouri July/Aug. 2014: National Roll Out of CoIIN: Regions I-III, VII-X, and Pacific Islands Infant Mortality Summits. Region VII-July 21-22, 2014 CoIIN Launch Meeting in Arlington, VA Pre-Summit Activity # 1 – Infant Mortality Plan – The Agenda states there will be time built in for each team to work on developing a state infant mortality plan during the summit, which the Missouri team is planning. Due date for this item is June 19 th (but this will be done at the Summit.) Pre-Summit Activity # 2 – State Infant Mortality Reduction Self-Assessment - DHSS will develop and circulate a draft of this document and request feedback from the team members via email before the due date. Due date for this item is June 27 th . Pre-Summit Activity # 3 – Data Systems and Capacity Survey - DHSS will complete this portion of the report and submit this for the Missouri Team. Due date is June 27 th . Pre-Summit Activity # 4 – Action Planning Worksheet
Missouri CoIIN Travel Team – July 2014 20 Cynthia Dean cdean@mbrcinc.org Chief Executive MBRC Officer Kendra Copanas kcopanas@stl-mcfhc.org Executive MCFHC, St. Director Louis, MO Title V Director MO DHSS Melinda Sanders Melinda.Sanders@health.mo.gov Samar Muzaffar Samar.Muzaffar@dss.mo.gov Medical MO DSS Director, MO Health Net Division Susan McLoughlin smcloughlin@mchc.net Executive MCHC, Director Kansas City, MO Venkata Garikapaty Venkata.Garikapaty@health.mo.g MCH MO DHSS ov Epidemiologist Catherine Lewis CLewis1@crmc.org OB Manager, MHA CRMC
MO IM CoIIN – Blueprint for change 21 States had to choose 3-4 strategic priority areas in that included the following components for the blueprint (September, 2014): Infant Mortality CoIIN Framework Stakeholders/ Strategic Potential Actions Outcomes Lead Timeli Resources Designate Priority (Change ne Identify additional team (3 – 4) Concepts) Anticipated stakeholders member outcomes for Selected from Selected from Estimat and/or resources who is each major Infant Infant Mortality ed necessary to responsib activity Mortality CoIIN Framework timefra implement actions. le for CoIIN me to driving Framework start/ the action end forward action
MO CoIIN Strategic Priority Areas 22 Increase access to and quality of prenatal 1. and maternal care Enhance access to and quality of care for 2. women before and between pregnancy Ensure quality of care for newborns/ infants. 3.
NICHQ Letter – Six Topics 23 November 18, 2014 “Dear State Infant Mortality CoIIN Teams, Thank you for your patience while the final list of IM CoIIN topics was finalized. We are impressed by how you are forging ahead with your IM CoIIN work. After reviewing the strategy topic areas identified by the expansion states in Regions I-III and VII-X, and the topics that Regions IV and VI identified for their CoIIN re-launch, as well as the CoIIN areas underway in Region V, we noted substantial overlap. In considering this alignment and recognizing that there are limited resources to support CoIINs in Regions IV/VI, Region V and the remaining seven regions, MCHB and the Infant Mortality CoIIN partners believe it would be most efficient and effective to proceed with a new model for CoIIN – a national (rather than regional) approach of 6 CoIIN strategy teams/topics rather than multiple, separate CoIIN strategy teams in Regions IV/VI, Region V and among the expansion states . This will provide states a chance to develop truly national collaboration and to learn from colleagues across the country. (contd..)” Lauren Smith, MD, MPH Executive Project Director NICHQ (National Institute for Children's Health Quality)
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