REDUCING INFANT MORTALITY THROUGH PERINATAL PERIODS OF RISK (PPOR) - - PowerPoint PPT Presentation

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 2005-20131
• We still have work to do…
• U.S. Ranks 25th out of 29 industrialized countries for

infant mortality1

• Enough infant deaths occurred in 2014 to fill 1,000

kindergarten classrooms2

• >$26 billion spent due to preterm labor3
• 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

• f 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

• Infant <365 days old
• Born in one of TFIMR counties
• Died in one of TFIMR counties
• Mother received prenatal care in one
• f TFIMR counties
• Manner of death is natural
• Accidental and unknown manner of

deaths are eligible if related to unsafe sleeping environments

Fetal

• Demise occurred >19 weeks gestation
• Delivered in one of TFIMR counties
• Mother received prenatal care in one
• f TFIMR counties
• Not the result of an elective

termination

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
• Okmulgee County
• Osage County
• Pawnee County
• Rogers County
• Tulsa County
• Wagoner 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
• utcomes
• Provides a realistic benchmark

Criteria

 White/Caucasian  Non-Hispanic  Twenty-five years of age and older  Associate’s Degree and higher  Resided in one of the eight counties analyzed at the time of delivery

Reference Population Maternal Health / Prematurity 1.9 Maternal Care Newborn Care Infant Health 1.4 0.8 0.8

PPOR Calculations

All Eight Counties Maternal Health / Prematurity 3.5 Maternal Care Newborn Care Infant Health 2.0 1.5 2.4 Reference Population Maternal Health / Prematurity 1.9 Maternal Care Newborn Care Infant Health 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 Maternal Health / Prematurity 3.0 Maternal Care Newborn Care Infant Health 1.7 1.2 2.2 Reference Population Maternal Health / Prematurity 1.9 Maternal Care Newborn Care Infant Health 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 Maternal Health / Prematurity 7.1 Maternal Care Newborn Care Infant Health 3.7 *Data not available 3.3 Reference Population Maternal Health / Prematurity 1.9 Maternal Care Newborn Care Infant Health 1.4 0.8 0.8

• Excess Deaths

Maternal Health / Prematurity 5.3 Maternal Care Newborn Care Infant Health 2.2 *Data not available 2.6

=

PPOR Calculations by Race: American Indian/Alaska Native

American Indian/Alaska Native Maternal Health / Prematurity 2.7 Maternal Care Newborn Care Infant Health 1.7 2.7 2.7 Reference Population Maternal Health / Prematurity 1.9 Maternal Care Newborn Care Infant Health 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 Maternal Health / Prematurity 1.1 Maternal Care Newborn Care Infant Health 0.3 0.4 1.4 Black/African American Maternal Health / Prematurity 5.3 Maternal Care Newborn Care Infant Health 2.2 *Data not available 2.6 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 Maternal Care Newborn Care Infant Health 1.9 1.4 2.4 Remaining Seven Counties 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

THANK YOU!

Questions?

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

Data Abstractor krobison@Tulsa-health.org 918.595.4464

Susan Hurtado, BSW

Community Specialist shurtado@Tulsa-health.org 918.595.4474

Rachel Erkenbeck-Hart, MPH

MCH Epidemiologist rhart@Tulsa-health.org 918.595.4463

Sandra Braun, MPH

MCH Epidemiologist sbraun@Tulsa-health.org 918.595.4428

For more information visit: www.ok.gov/health/Community_&_Family_Health/Improving_Infant_Outcomes/index.html