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Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality Veronica L. Gunn, MD, MPH Chief Medical Officer, TN Dept of Health.

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Presentation on theme: "Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality Veronica L. Gunn, MD, MPH Chief Medical Officer, TN Dept of Health."— Presentation transcript:

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2 Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality Veronica L. Gunn, MD, MPH Chief Medical Officer, TN Dept of Health Michael D. Warren, MD Medical Director, Governor’s Office of Children’s Care Coordination

3 We have no financial conflicts to disclose. We will not be discussing off- label use of pharmaceuticals in this workshop.

4 45 th for Births to Teens 43 rd for Low Birth Weight Babies 43 rd for Preterm Births 45 th for Infant Mortality Tennessee in National Rankings Annie E. Casey, Kids Count, 2008 (based on 2005 data)

5 Infant Mortality Initiative-- Background March 2006 Comptroller’s Report Racial Geographic Multifactorial risk factors for poor birth outcomes Former DOH Commissioner, Dr. Kenneth Robinson

6 Infant Mortality Initiative-- Background GOCCC requested to lead collaborative effort State legislature appropriations Infant Mortality Initiative ($1.44M recurring) Monies draw 50% Medicaid match; efforts must be geared toward Medicaid-eligible population Women’s Health Initiative ($5M, $3M recurring) Monies indicated to increase access to and utilization of prenatal and obstetric care in underserved areas of the state

7 Guiding Principles Use data to inform strategy development Use Evidence-Based Practices when available Evaluate all efforts Develop partnerships to promote cooperation and collaboration Empower the community to drive initiatives and instigate change

8 Step 1: Identify Where the Problem is Located

9 Infant Mortality Trends: TN and US, BHIAT 2010 goal

10 Tennessee White Population Tennessee Black Population

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12 Infant Mortality Rates,

13 Rates vs. Absolute Numbers:

14 Priority Areas 10% 28% 5% 1.Shelby County 2.Davidson County 3.Hamilton County Percent of Infant Deaths in Tennessee by Area,

15 Step 2: Identify the Cause of the Problem

16 Perinatal Periods of Risk (PPOR) Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Fetal Neonatal Post- neonatal grams grams WEIGHT AT BIRTH AGE AT DEATH Adapted from City MatCH, CDC

17 Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Preconceptual Health, Health Behaviors Prenatal Care, High-risk Referral OB Care Perinatal Management Neonatal Care Pediatric Surgery Sleep Position Breast Feeding Injury Prevention Intervention Points CityMatCH. “Perinatal Periods of Risk Approach in U.S. Cities.” January,

18 Causes of Infant Mortality 1. Disorders Related to Preterm Birth and Low Birth Weight 2. Congenital Abnormalities 3. Sudden Infant Death Syndrome (SIDS)

19 Determinants of Infant Mortality in Tennessee Higher Risk Factors Rate per 1000 live births Lower Risk Factors Rate per 1000 live births Premature birth51.0Term birth3.4 No prenatal visits46.0≥1 prenatal visit8.0 Twins or more37.5Single birth7.7 Black18.0White7.0 Single mother12.7Married6.3 Smoking12.0Non-smoking7.7 Non HS graduate11.9College graduate4.6 Urban resident10.3Rural resident7.4 From: TN DOH, 2003

20 Pregnant Smokers by Region

21 Memphis Community Survey Early childhood development polls—First Years Institute, University of Memphis Memphis/Shelby County Reflective of early childhood public awareness campaign Public awareness of issues related to infant mortality was quite high

22 What would you say is the single most important problem facing your local community, that is the one that you, yourself are most concerned about?

23 “Infant mortality is not a health problem. Infant mortality is a social problem with health consequences.” Marsden Wagner, Statement to the National Commission to Prevent Infant Mortality

24 Factors Influencing Birth Outcomes Maternal and Infant Heath Personal Choices Knowledge Information Societal Values Families & Communities Access to Services Utilization of Services Effectiveness of Services Social & Economic Conditions

25 Step 3: Action A. Build Capacity

26 Build Capacity Metro Infant Mortality Coordinator Metro Infant Mortality Coordinator Metro Infant Mortality Coordinator

27 Build Capacity Metro Infant Mortality Coordinator Metro Core Leadership Group GOCCC Academic Institutions Faith Community Local Businesses Hospitals Non-Profit Organizations Community Agencies

28 Step 3: Action A. Build Capacity B. Implement Evidence Based Solutions

29 Implement Evidence-Based Programs Grants to enhance infrastructure and accessibility through personnel and equipment Centering Pregnancy Community Voice Smoking Cessation intervention for pregnant women in Northeast Tennessee Fetal Infant Mortality Review (FIMR) TN Initiative for Perinatal Quality Care

30 Exercise 1: Using Data to Identify Priorities

31 Exercise 2: Establishing State-Local Collaborations

32 Exercise 3: Promoting Sustainability

33 Prevention is the Key $10 per person annually= $16 billion saved Tennessee could save $351 million (ROI of 6 to 1) Trust for America’s Health, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, July 17, 2008.

34 Tying it Together… Cross-pollination Enhances service delivery Promotes sustainability Community Voice referrals to and from Centering Pregnancy TIPS connections to 5A through HUGS and TN Quitline ( QUIT-NOW) MCO utilization of Centering Pregnancy as a disease management model

35 Neonatal Hospital Costs by Gestational Age at Birth for Surviving Infants Gestational Age (weeks) Neonatal Cost 25$202,700 26$146,600 27$119,600 28$86,200 29$62,600 30$46,400 31$29,800 32$18,900 33$11,000 34$7,200 35$4,200 36$2,600 37$1,700 38$1,100 Gilbert et al, weeks 34.8 weeks $14,000 $4,700 Savings per Preterm pregnancy $9,300

36 Pregnancy Savings with Centering Pregnancy in TN Neonatal Hospital Costs: Number of Preterm Pregnancies in TN (2004) Savings per Preterm Pregnancy Total Potential Savings 9,848 X$9,300 $92,516,400 Postneonatal hospital costs Postneonatal outpatient costs Infant and child excess medical costs attributed to preterm birth

37 Average Cost of Hospital Care In 2005, hospital costs associated with pregnancy were $40 billion, second only to the $41 billion of charges incurred for heart disease Cost of prematurity represents about 33% of a state’s total medicaid budget March of Dimes, 2005

38 Costs of Preterm Birth (billions of $) 67% Medical Costs Labor & Market Productivity 22% Special Education 4% 7% Maternal Delivery $26 Behrman RE et al., Preterm birth: causes, consequences, and prevention. Institute of Medicine. Nat’l Acad. Sci. (2006).

39 The Economic Impact In the U.S. the total annual health care charges for all infants totals $33.8 billion $15.5 billion of this (nearly half) is for premature births The average premature baby has a health care cost in the first year of life totaling $41,610 A healthy baby has an average cost of $2,766


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