1. Broadening the Work of Prematurity and Infant Mortality Partnerships to Address Preconception Health: the Kentucky Experience
Ruth Ann Shepherd, MD, FAAP
Director, Division of Maternal and Child Health
Kentucky Department for Public Health
Connie Gayle White, MD, MS, FACOG
Women’s Health Consultant
Founding Member, Every Woman Southeast

2. KY Partnerships on Prematurity
Kentucky Folic Acid Partnership
Since 1998; partnership with March of Dimes
Over 100 members, 80 agencies across the state
Prematurity Toolkit, HBWW project name
Prematurity activities since 2005 (278,000 individual, 1.7M media)
Prematurity Summits- MOD and KPA – spring and fall
2004: “Prematurity, the Scope of the Problem” Frank Boehm
2005: “The Prematurity Problem: The Kentucky Data”
2006: “The Infant Born at 36 weeks is still Preterm”
Kentucky Perinatal Association
HPEP – Health Professional Education on Prematurity
HPEP I - Pathways to Prematurity
HPEP II – Late Preterm Infants – 2007
HPEP III – Progesterone – 2009
National Perinatal Association Awards to KPA
Innovation Award 2006
Best Chapter 2009
Pilot Projects: PRAMS, FIMR, GIFTS

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4. A Collaborative Partnership
The Prematurity Prevention Partnership
March of Dimes
Johnson & Johnson Pediatric Institute
Kentucky Department for Public Health
Kentucky March of Dimes Chapter
Professional organizations (ACOG, AAP, AWHONN)
Kentucky perinatal leaders 4

5. Media Launch in Louisville, KY March 2007
Dr. David Smith, Dr. Jennifer Howse, Governor Ernie Fletcher, Dr. Steven Shelov, Mr. Shawn Crabtree

6. Overview
HBWW® is a three year ( ) pilot program that aims to reduce “preventable” preterm births at three Intervention Sites in Kentucky
Goal: 15% reduction in the rate of singleton preterm births at the intervention sites
Mixed ecological “real world” design
Focus on late preterm birth (34-36 weeks)
Collaboration between hospitals, obstetricians, and public health professionals and the local community
Provides education for pregnant women, the community and perinatal providers
Essential for HBWW interventions, implementation and evaluation include the:
collaboration between each clinical intervention site and the local Kentucky Departments of Health (DOH) that provide services for pregnant women in each intervention site’s catchment area
partnership between the clinical teams and their hospitals’ public relations teams for media outreach 6

7. These are the 3 intervention and 3 comparison sites in eastern, central and western Kentucky
Sites were chosen to represent a variety of geographic areas of the state
~12,000 live births to be included in the study, from all 6 Sites
Comparison Sites
Geographically disparate to minimize contamination
Somewhat comparable with respect to baseline data
Provided a mechanism to track temporal changes in policies and practices
Baseline and follow up consumer/provider surveys, annual epidemiological policy interviews, and perinatal program surveys 7

8. HBWW Advisory Council
Biannual Site Council Meetings with leaders representing:
Participating agencies in KY (DPH: Commissioner, Director MCH, HANDS Coordinator, State Epidemiologist, etc.)
Perinatal professional organizations in KY (ACOG, AWHONN, KPA)
State March of Dimes
Intervention sites (both hospital and health dept each site)
Executive Program Board (national partners and project PI)
Clinical experts in ob/gyn, maternal fetal medicine, neonatology, pediatrics, family medicine, oral health, smoking cessation
Communications/media experts
Working Groups
Intervention, Evaluation, Communication, ad hoc

9. Healthy Babies are Worth the Wait Interventions
“Bundled” Evidence-Based Interventions
Linked elements of clinical care, patient support, and public education:
Partnerships
Advisory Council, Local Implementation Teams,
Local meetings with office managers, etc.
Professional Education & Action
Grand Rounds & Training
Standard clinical guidelines (folic acid, smoking cessation, progesterone, screenings)
Patient safety protocols
Patient Education and Action
Augmenting existing services for case management,
screening & referral
Health Literacy in the context of prenatal care
Public/ Community Education and Action
Community Toolkit
Media toolkit
Web site 9

10. HBWW® Health Messages See the doctor BEFORE & DURING pregnancy
Don’t smoke or use alcohol while pregnant
Take folic acid every day
Brush, floss and visit the dentist
Avoid scheduled delivery before 39 weeks
Babies’ brains grow a lot between 35 and 40 weeks
These concise messages were created for additional products (next slides)

11. HBWW® Materials Oral Health Products Stamped with website URL
Message Pens
Magnetic Photo Frames
Message Totes
Incentives for follow-up consumer survey

12. HBWW® Materials Brain Card Not to be distributed directly to patients
Utilized by providers to facilitate communication with patients

13. This Late Preterm Brain Development card is available from the March of Dimes and is for use by health care providers (e.g. physicians, midwives, nurses, physician assistants).
It is designed to present a graphic representation of fetal brain growth and maturation in the last month of pregnancy. Specific information is summarized in the 5 bulleted points describing some of the increased risks for late preterm compared to term infants. As clearly stated at the end of the card, it is strictly informational and not intended to be used as medical advice. The card also encourages the pregnant woman to discuss concerns with her health care provider.
It is important that the card be used in the context of a discussion with a provider. The card should not be simply passed out to pregnant women. A consumer brochure will soon be available to provide additional information about late preterm birth which can be given to pregnant women and interested consumers. 13

14. State and National Outreach - 26 state professional meetings
Community Outreach Education & Action
Community Toolkit (KFAP)
Message: Preventing Prematurity saves babies lives and improves the future for families and for communities.
Fact Sheets, Handouts, Powerpoint, Instructions for Activities, Reporting form, evaluation
English and Spanish
Media in Intervention Communities
Media Toolkit for traditional media
Hospital and health department media teams
Digital media interventions
Facebook, Twitter
State and National Outreach
- 26 state professional meetings
- 12 national meeting presentations
- nearly 100 media coverages

15. Web-based Resources: www.PrematurityPrevention.org
Jan Mar. 2009
Total visitors: 36,334
Most materials available for download from website
Also available for free download is a Pregnancy Diary computer program from JJPI; It is a fun, interactive way to track pregnancy

16. Provider “Grade Card” sample
Summary of Inductions and Scheduled C/S of Infants prior to 39 wks GA
PHYSICIANS
Total
Medical Indication
Medical Indication Rate
Infants Admitted to NICU Who Were Induced or Sectioned Without Medical Indication
Doc A 5
100%
Doc B 3 1
33%
Doc C 2
Doc D
66% 16

17. Late Preterm Birth Monthly Comparisons (percent of deliveries)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
YR Avg
2006 11 10 18 13 20 8 16
2007 14 21 12 7 9
2008
2009 6 19

18. Partnership Example
Initial Grand Rounds included information on periodontal disease and prematurity
Discussions with providers  no local dentists would see pregnant women
From HBWW Advisory Committee, national oral health expert (Dr. John Novak) agreed to provide educational session
HBWW team and Local Dental Society partnered to sponsor combined educational session for medical and dental providers

19. After the educational session, some local dentists more willing to accept pregnant patients
HBWW team meeting with OB office managers got feedback that only some dentists were participating
HBWW team followed up with each local dentist, providing additional materials and answering remaining questions about dental care for pregnant women
Additional dentists in the area agreed to provide dental care for pregnant women
Office mangers now reporting they are able to get women in for dental care most of the time.

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