1. DOING PRECONCEPTIONAL HEALTH: LOCAL REALITIES Marjorie Angert, D.O., MPH, Director of Medical Affairs, Division of Maternal, Child and Family Health, Philadelphia Department of Public Health

2. PHILADELPHIA INFANT MORTALITY, 1995-1998

3. Philadelphia PPOR Results, 1997-99 (95% C.I.) Maternal Health/ Prematurity Maternal Care Newborn CareInfant Health Lower North HS 10.7 (8.1-13.8) 3.8 (2.3-5.9) 2.7 (1.5-4.5) 3.6 (2.2-5.6) All Phila. n=65,849 5.6 (5.0-6.2) 2.9 (2.5-3.3) 1.4 (1.1-1.7) 2.3 (2.0-2.7) Reference* n=8233 2.1 (1.2-3.3).85 (.3-1.8).85 (.3-1.8).61 (.2- 1.4) *Philadelphia Residents, White, non-Hispanic, 13+years of education, 20+ years of age

4. PHASE II ANALYSIS Chronic Hypertension Previous Preterm Delivery High Parity for Maternal Age

5. PARTNERS ASSEMBLED Philadelphia Department of Public Health (Division of Maternal, Child and Family Health) Healthy Start Staff Health Clinic Providers and Staff North Philadelphia Alliance

6. LINKING PPOR TO THE COMMUNITY Healthy Start has been working with the North Philadelphia Alliance (community board): medical providers, patients, CBOs, faith-based organizations Team presented PPOR to the Alliance Alliance and local partners learned risk factors for prematurity and infant mortality in their community

7. PUTTING TOGETHER LOCAL TEAM Team identified local partners for strategic planning at the health center: MCFH staff: medical director and administrator for family planning/gyn services; HS program manager, Consortium developer and epidemiologist Health Center staff: administrator, medical director, health care coordinator, family planning nurse practitioner, gynecologist, primary care provider, clerical staff and social worker

8. INTERVENTION STRATEGIES Strategies will include the Healthy Start case manager and require collaboration between family planning and family medicine: 1. Women with a positive or negative pregnancy test will be connected with Healthy Start at that visit. 2. Women seen in family planning who have medical risk factors for preterm birth will be referred to Adult Medicine for treatment and to Healthy Start for education and coordination of interconceptional care. 3. Women with history of preterm birth will be referred to Healthy Start for education and, if needed, case management services.

9. INTERVENTION STRATEGIES (cont.) 4. We will meet with primary care staff to discuss their role in decreasing infant mortality through preconceptional care: Medical conditions and social behaviors predate the pregnancy 40%-50% of pregnancies are unplanned Need to integrate preconceptional screening into H & P

10. BARRIERS Lack of knowledge among community and medical providers about the importance of preconceptional care Limited opportunities to meet with medical staff Lack of screening tool for risk factors for medical providers Inadequate staff

11. BARRIERS (cont.) Complicated consent and confidentiality issues when two organizations (Health Center and Healthy Start) collaborate Need to understand at an emotional level what it is like to have a premature baby or an infant death

12. LESSONS LEARNED PPOR data is powerful, but is only the first step All partners must be at the table early on and be part of the process Have the meetings on site and at regular intervals Recognize that the program evolves over time - it is a process

13. LESSONS LEARNED Community involvement is critical Look for help from the institutions in your city Evaluation is an important part of the process