Perinatal Periods of Risk-A Tool for Improving the Health of Mothers and Infants Carolyn Slack, MS, RN Columbus (OH) Health Department

Feto-Infant Mortality Franklin County, Ohio, All Races Maternal Health/ Prematurity 123 Maternal Care 71 Newborn Care 43 Infant Health Feto- Infant Deaths 32,673 Fetal Deaths & Live Births

Background WHO and Dr. Brian McCarthy CityMatCH PPOR Work Group Why a new approach to infant mortality?

National Practice Collaborative Description of the PPOR Practice Collaborative Application Process Practice Collaborative Curriculum Participating Cities –Baltimore, MD, Columbus, OH, Durham, NC, Jacksonville, FL, Kansas City, MO, Louisville, KY, Nashville, TN, New Haven, CT, Orlando, FL, Philadelphia, PA, Phoenix, AZ, Portland, OR, Raleigh, NC, and St. Petersburg, FL.

Community Readiness: From Concepts to Tools Tool for engaging partners Tool for reaching consensus Tool for identifying joint assets Tool for revealing critical gaps Tool for developing strategy What shape is your tent?

Raising the roof for PPOR: Reasoning Roles Resources Risk/Rewards Results What shape is your tent?

PPOR Community Readiness “5 Tent Poles” 1. Reasoning: partners can communicate clear, compelling case for PPOR based on its value-add 2. Results: partners can articulate what measurable results are expected from doing PPOR, and by when 3. Roles: partners are willing and able to champion PPOR over a time in their various roles in the community 4. Risks/Rewards: sufficient strategic balance exist between benefits and consequences for essential stakeholders to support PPOR implementation 5. Resources: sufficient systems and resources to support full implementation

PPOR Partnerships in Columbus Lead Partners & Columbus Health Department Caring for 2 (Healthy Start) Other Partners Child Death Review Team WIC/CFHS (Title V) Advisory Council Council on Healthy Mothers and Babies Ohio Dept. of Health

Linked Birth & Death Certificates Infant Deaths Live Birth Certificate Birth Characteristics Infant Death Certificate Death Characteristics Fetal Deaths Fetal Death Certificate

Birth Versus Death Cohort Birth Cohort Births Deaths Death Cohort Births Deaths

Data Recommendations Need at least 60 deaths in every population you want to study No more than 5 years of data due to changes in medical practice Assess data quality –Missing birth weight and gestational age –Missing education and race

Map of Feto-Infant Mortality What Is Missing in the 6 Cells? n Fetal deaths restricted to n n n >500 gLive births restricted to Spontaneous abortions Induced abortions  24 wks and  500 g n

Feto-Infant Mortality Franklin County, Ohio, All Races Maternal Health/ Prematurity 123 Maternal Care 71 Newborn Care 43 Infant Health Feto- Infant Deaths 32,673 Fetal Deaths & Live Births

Feto-Infant Mortality Rates Franklin County, Ohio, All Races Maternal Health/ Prematurity 3.8 Maternal Care 2.2 Newborn Care 1.3 Infant Health 2.5 Feto-Infant Mortality Rate = 319 x 1,000 32,673 = 9.8 deaths per 1,000 births & fetal deaths

Excess Feto-Infant Mortality Franklin County, Ohio, = Franklin Co. All Races U.S. Reference Excess

Feto-Infant Mortality Rates Franklin County, Ohio, Black Maternal Health/ Prematurity 5.8 Maternal Care 3.8 Newborn Care 1.6 Infant Health 5.5 Feto-Infant Mortality Rate = 106 x 1,000 6,349 = 16.7 deaths per 1,000 births & fetal deaths

Excess Black Feto-Infant Mortality Franklin County, Ohio, = Franklin Co. Black U.S. Reference Excess

Excess Feto-Infant Mortality Overall and Black Franklin County, Ohio, Franklin County Overall Excess Black Excess

Infant Health – Phase II Franklin County, Postneonatal deaths of birth weight of 1500 grams or above

Prevalence of Selected Risk Factors Franklin County, *Postneonatal deaths of birth weight of 1500 grams or above

Issues and Plans Vital Statistics - Statewide Availability of matched certificates Street address vs. census tracts Completeness of data Source of congenital anomalies data NCHS perinatal mortality data files EBC plans and access

Issues and Plans Vital Statistics - Local Completeness of data –Follow-up and training of VS staff, hospital and other medical personnel Cause of death problems Missing certificates

Issues and Plans Our Response Create our own electronic database –Using Child Death Review data Improve process to get out of county certificates Continue to work with fetal death data

Issues and Plans Other Stuff Focus on singletons Use of other data sets for next level of analysis –e.g., programs: STD, CFHS, NHCs –e.g., surveillance: PRAMS, BRFSS

Issues and Plans Other Stuff Talk in terms of excess deaths, rather than rates Power of selecting an internal reference group (must be at least 15% of population) Examine PTB and C-section rates Multiracial moms

Issues and Plans One Parting Thought… An Ohio MCH/PPOR Collaborative –Based on national (City MatCH) model –Possible funding through MOD

Acknowledgements Kelly Welch Williams, MS, Caring for 2 Project Director Kathleen Cowen, MS, Senior Epidemiologist – Columbus Health Department

For Further Information, visit the CityMatCH website: