Preventing Low Birthweight Infants Through Effective Clinical Collaboration Salt Lake Valley Health Department Audrey Stevenson PhD & Iliana MacDonald MPA

This session will detail best practices that have been achieved through collaboration and aligning resources to at-risk individuals in the population. The result has been healthier outcomes for both mothers and babies in our community.

Objectives State strategies to reduce the number of Low Birthweight (LBW) Infants born to women receiving services through the Clinical Collaboration at the SLVHD compared to State and County LBW percentages List the collaborations and partnerships used to reduce LBW infants born in Salt Lake County

Low Birthweight (LBW) Defined LBW defined as an infant weighing less than 2500 grams or 5 ½ pounds at birth Healthy People 2010 goal is for LBW births to be reduced to no more than 5% of live births

Public Health Implications We know that the annual societal costs associated with low birthweight infants are staggering. Through the use of this collaboration, we have been able to reduce the number of low birthweight infants and prevent the human and societal impact the LBW infants can cause.

Societal Costs Healthcare costs are six times higher and the length of hospital stay is higher for LBW infants weighing between 1,500 and 2,499 grams Healthcare costs are 85 times higher for newborns born weighing less than 1,500 grams Annual societal cost (medical, educational, and lost productivity) associated with preterm birth was at least $26.2 billion

Public Health Implications Utah has ~52,000 births per year Approximately half of Utah births occur in Salt Lake County. The 2006 statewide percentage of low birthweight (LBW) infants born in Utah was 6.9%. The Salt Lake County LBW percentage was 7.4%. The LBW percentage for the participants of the SM collaboration (6.2) is lower than either the state or county percentages. (p>0.5)

LBW Percentages 2006

Low Birthweight Infants Having a program that has a lower birthweight percentage than either the Statewide or County percentages has been a significant accomplishment. Particularly when one considers that the South Main Clinic provides services to an at-risk population.

Utah Birth Rate During a 12-month period in 2005 and 2006, Utah saw 83.2 births per 1,000 women of child-bearing age, compared with the national average of just 54.9 births per 1,000 women. Salt Lake Tribune August 19, 2008

The Collaboration The SLVHD-University Consortium Collaboration provides prenatal services at two clinical sites in Salt Lake County. This clinic has served as a safety net to provide prenatal services to teens, women without other access to healthcare, high-risk pregnant women and their children.

Collaborations SLVHD University of Utah College of Medicine University of Utah College of Nursing

Clinical Sites South Main Public Health Center Ellis R. Shipp Public Health Center

Programs Provided Antepartum and postpartum Teen Mother and Child Program High Risk Prenatal Clinic Substance Abuse Project for Women WIC Immunizations Oral Health Program Pediatrics Promotoras Medicaid Eligibility Workers Nurse Home Visitation Programs On-site Ultrasound Non-stress Testing

Why the Practice is Innovative This model is unique by providing integrated prenatal services in a community setting with surrounding public health services resulting in a rate of low birthweight infants lower than either the State or County rates.

Addressing the Issue The Salt Lake Valley Health Department partnered with the U of U Department of Medicine to provide prenatal care to under- served women in Salt Lake County.

The Collaboration One goal of this collaboration is to provide comprehensive antepartum care with surrounding public health services at the South Main Clinic. The result has been a level of antepartum service that exceeds the care possible by either agency outside of this collaboration.

Barriers The success of this project is the sharing of resources between multiple agencies. The equal engagement of all partners has enabled this practice to expand to include high risk pregnancies, pregnant women with substance abuse problems, and teens.

Partnerships with other Agencies Grants have been awarded to various partners to help defray the cost of some services such as the provision of an on-site ultrasound and sonographer, dental cleanings for women between weeks gestation and a nurse home visitation program for all newborns and an intensive nurse home visitation program for first time mothers.

Importance of Partnerships With increasing costs and dwindling resources the continued support between stakeholders is vital to the success and sustainability of this practice.

Conclusion The SM Clinical Collaboration has successful at reducing the number of LBW infants to a percentage that is lower than either the State or County percentages This program has been successful because of the strength and commitment of the partnerships