translating data into action: using ppor, fimr, and the lamb project to reduce infant mortality...
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Translating Data into Action:Using PPOR, FIMR, and the LAMB Project to Reduce Infant Mortality
Cynthia Harding, MPH
Giannina Donatoni, PhD
Los Angeles County Department of Public Health
Maternal, Child and Adolescent Health Programs
Special Thanks to:
Cathleen Bemis, MS
Shin Margaret Chao, PhD, MPH
Kevin Donovan, MPH
Sunching Glenn, MS
Angel Hopson, MSN, MPH, RN
Laurin Kasehagen, PhD, MA
McKinley Kemp, MBA
Grace Lubwama, MPH
Today’s PresentationData tools
Perinatal Periods of Risk (PPOR) Fetal and Infant Mortality Review (FIMR) Los Angeles Mommy and Baby (LAMB)
Project
Findings
Data to
Los Angeles, California
1
Antelope Valley (AV)
Relatively isolated
4,903 live births in 2002 Mother’s race/ethnicity:
17% African American 46% Hispanic 33% White
Income of 1 in 8 households less
than Federal Poverty Level (1 in 5 in LAC).
Increasing Infant Mortality in AV
1999-2002
4.95.4 5.5
5.4
5.0
6.2
9.4
10.6
0
2
4
6
8
10
12
1999 2000 2001 2002
per
1,00
0 L
ive
Bir
ths
LAC Overall Rate
AV Rate
Countywide IM rates were 4.9 to 5.5 from 1999-2002
AV IM rate more than doubled between 1999 and 2002
In 2002, there were 4903 live births and 53 infant deaths in AV*
* Small numbers cause large changes in rates
Highest Rates in African Americans
African American rate increased from 11.0 in 1999 to 32.7/1,000 live births in 2002
19.0
28.4
32.7
5.7 5.6
7.7
3.5
5.5
11.0
6.6
2.7 2.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1999 2000 2001 2002
Per 1
,000 L
ive Bi
rths
African American Hispanic
White (Non-Hispanic) Antelope Valley Rate
Source: California Department of Health Services, Center for Health Statistics, Vital Statistics, 1999 to 2002
Response
PPOR Focus AreaPotential
Community/PH Interventions
Maternal Health/Prematurity
Preconceptual HealthHealth BehaviorsPerinatal Care
Maternal CarePrenatal CareReferral SystemHigh Risk OB Care
Newborn CarePerinatal ManagementPerinatal SystemPediatric Surgery
Infant HealthSleep PositionBreast-FeedingInjury Prevention
Data Source: Birth Cohort data, California Department of Health Services, Center for Health Statistics, Vital Statistics, 2002.
Fetal Infant MortalityReview (FIMR) / PPOR
National FIMR forms to review 2002 AV infant deaths (N=53)
PHNs conducted home interviews, abstracted hospital and provider records.
PPOR framework to summarize findings by each infant’s birth weight and age at death.
Population-based, case control Resided in AV Factors linked with poor birth outcomes Events before, during, and shortly after pregnancy
Pre-interconception care Prenatal care Maternal medical conditions Psychosocial factors Risk taking behaviors
Los Angeles Mommy and Baby (LAMB) Project
FIMR/PPOR Findings27 Neonatal Deaths (<1500 g, 0-28 days)
Mother:All had at least one risk factor for poor birth outcomes65% had psychosocial issues54% had an infection – mostly UTI and STD35% began prenatal care after 12th week
Infant:22% had documented infection15% had congenital birth defect
FIMR/PPOR Findings (continued)13 Infant Deaths (> 1500 g, 29-365 days)Mother:85% had at least one risk factor for poor birth outcomes77% had psychosocial issues54% began prenatal care after 12th week
Infant:54% had issues related to safety 46% had a congenital birth defect
LAMB Findings Moms with poor birth outcomes tend to have:
No insurance before pregnancy (OR=2.3; p = 0.004)
Previous low birth weight/preterm infant (OR=3.67; p = 0.0003)
High blood pressure during pregnancy (OR=3.44; p=0.06)
Inadequate prenatal care (OR=2.34; p= 0.01)
Early labor pain, water broke early (OR=2.54/10.93; p <0.001)
Felt less happy during pregnancy (OR=1.92; p= 0.02)
Smoked during pregnancy (OR=3.19; p= 0.005)
Unsafe neighborhood (OR=2.45; p= 0.02)
Data FrameworkPPOR, Infant Death Review and LAMB
PPORIdentify groups with excess mortality.
Link births with deaths.
Mortality ReviewMaternal interviews
& chart reviews
Share findings with stakeholdersat local community meetings
LAMBPopulation-based case control study
Calculate prevalenceof problems
Identify factors assocwith LBW/PT births
Community consensus onrecommended actions
Where do we intervene?
Maternal Health/
Prematurity
1. Preconception care
2. Interconception care
3. Prenatal care
4. High risk Ob care
Infant Health
1. Safety issues
(sleep position, injury
prevention, etc)
2. Breast-feeding
3. Family and parenting
issues
?
?
Areas for Strategic Intervention
Maternal Health/
Prematurity
1. Preconception care
2. Interconception care
3. Prenatal care
4. High risk Ob care
Infant Health
1. Safety issues
(sleep position, injury
prevention, etc)
2. Breast-feeding
3. Family and parenting
issues
12 Short-term Interventions 1.Increase access to high-risk Ob care and
related ancillary services, such as labs; access is particularly difficult for Medi-Cal recipients.
2.Arrange faith-based youth services to provide health services.
3.Promote “100 Acts Kindness” for pregnant women.
4.Increase access to transportation for pregnant moms and advocate politically for trans. improvement.
5.Arrange male support groups to address the ”Role of Men”.
6.Present this data to local Ob and pediatric providers and staff to increase awareness.
7.Provide comprehensive assessment for newborns, especially for high risk ones.
8.Provide immediate information and planned follow-up for high-risk infants/moms.
9.Provide newborn infant care classes to new moms before they are discharged from the hospital.
10.Establish a 24-hour lactation team.11.Provide education for breastfeeding and
infant care during prenatal care.12.Bring providers and volunteers together to
identify best practices.
Translating Data to Action
Service Expansion and Linkages Antelope Valley Best Babies Collaborative Faith-Based Efforts Better hospital discharge planning Better linkage to MCAH Programs
Nurse Family Partnership Black Infant Health CPSP
Preconception Health Efforts Perinatal Summit Preconception Health Collaborative
Community Engagement Training for Providers Integration with existing public health practice
Maternal Health/
Prematurity
Community Engagement Brochures on the Web
Pregnancy & Family Friendly Workplace Policies Brief
Breastfeeding-Friendly Workplace Policies Brief
How healthy are you? Reproductive Life Plan toolkit
Your Health, Your Life Plan: A Reproductive Health Life Planner for all Ages
Community Engagement Palm cards, posters, and DVDs
I Want my 9 Months Don’t U Dare Are You Ready for a Makeover? Nine Questions to ask Before Becoming Pregnant Folic Acid is Good for Me / Folic Acid is Good for
Us Community grants and awards Advocacy network
Infant Death Rate by Race/Ethnicity Antelope Valley, 1996-2005
15.1
17.619.1
11.0
19.0
28.4
32.7
16.5
14.3
9.5
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Infa
nt
Death
s p
er
1,0
00 L
ive B
irth
s
African American Asian/Pacific Islander Hispanic White Total
Contact Us:Los Angeles County Department of Public Health
Maternal, Child, and Adolescent Health Programs
Cynthia A. Harding, MPH , Director
Giannina Donatoni