1 / 101

P erinatal P eriods O f R isk From Data to Action to Improve Women and Infants’ Health

A CityMatCH How-to-do Workshop. P erinatal P eriods O f R isk From Data to Action to Improve Women and Infants’ Health. The PPOR “How to Do” Workshop will result in: Learning how to assess “community readiness” Recognizing and understand all components of the PPOR Approach

lavalle
Download Presentation

P erinatal P eriods O f R isk From Data to Action to Improve Women and Infants’ Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A CityMatCH How-to-do Workshop PerinatalPeriodsOfRisk From Data to Action to Improve Women and Infants’ Health

  2. The PPOR “How to Do” Workshop will result in: • Learning how to assess “community readiness” • Recognizing and understand all components of the PPOR Approach • Achieving a common understanding of what it takes to conduct the first phase of analysis • Learning how to shift focus from PPOR data to using the PPOR Approach for systems change • Obtaining certification to participate in upcoming CityMatCH PPOR Level 2 activities

  3. Infant Mortality Rate,Urban County, 1990-2001 * White rate for 2001 is provisional Source: DHHS

  4. 2001 Infant Mortality Rate,Urban County vs. State * Questionable due to small numbers Source: DHHS

  5. Why Do We Need Another Way to Look at Infant Mortality? • Current approaches do not always identifygaps in community resources. • Current approaches do not targetresources for prevention activities. • Current approaches do not use locally determined benchmarks to define disparities

  6. PPOR: From Data to Action

  7. PERINATAL PERIODS OF RISK  PRACTICE COLLABORATIVE: 14 Participating U.S. Cities, 2000 - 2002  Baltimore Columbus Durham Jacksonville Kansas City Louisville Nashville New Haven Orlando Philadelphia Phoenix Portland Raleigh St. Petersburg PPOR-PC Partners

  8. PPOR - PracticeCollaborative Our purpose is to determine and describe, together, the best practices in using the Perinatal Periods of Riskapproachas a tool to improve maternal and infant health in communities… and, when necessary, to further develop, modify and strengthen the approach for its best use.

  9. “PPOR” is about : • Adding new tools to help solve some very old problems • Translating data intoaction • Changingthe way we do business

  10. Headline News… • Locally-defined disparities serve to target further investigations and tailor prevention • —Ken Gross, Philadelphia PA • Successful integration of PPOR, FIMR, Healthy • Start yields better prevention of feto-infant deaths • —Violanda Grigorescu, Louisville KY • Stronger local/state partnership builds better • data capacity to address health disparities • —Carolyn Slack, Columbus OH • State-level “Practice Collaborative” model promotes consistent best uses of PPOR in urban areas • —Carol Brady, Jacksonville FL

  11. The Value-Add of PPOR:…..from Knowing to Doing • Builds data and epi capacity • Promotes effective data use • Strengthens essential partnerships • Fosters integrationwith other key efforts • Localizes assessment to action process • Encourages evidence-based interventions • Helps leverage resources • Enables systems change for perinatal health

  12. Perinatal Periods Of Risk…a comprehensive approach • Bring community partners together to build consensus, support, and partnership. • “Map” fetal & infant deaths by birth weight & age at death. • Focus on understandingthe overall fetal-infant death rate. • Look for “opportunity gaps” between different groups. • Target further investigations and actions on the gaps. • Mobilize for sustainablesystems change.

  13. 6 Basic Steps: Perinatal Periods of Risk Approach • Bring community partners together to build consensus, support, and partnership.

  14. PPOR: a Tool for Planning Readiness Needs Assessment Investment Strategies Evaluation Monitoring Plan Implementation

  15. PPOR Framework

  16. Improve Maternal & Infant HealthSeeing the “Big Picture”

  17. 6 Basic Steps: Perinatal Periods of Risk Approach • Bring community partners together to build consensus, support, and partnership. • “Map” fetal & infant deaths by birth weight & age at death.

  18. Building thePPOR“Map”: What data do we use? • Uselinkedinfant birth – death file • Include fetal deaths

  19. Why include fetal deaths? • Fetal deaths may have similar causes as infant deaths. • Fetal development is part of a continuum that runs from conception to the 1st birthday. • The determination of “fetal” versus “infant” death is based on judgment. • Including fetal deaths increases analytic power.

  20. PPOR Map of Fetal-Infant Mortality:What events are not included? • Fetal deaths that occur before 24 wks • Fetal deaths weighing under 500 grams • Live births weighing less than 500 grams • Spontaneous and induced abortions

  21. Developing the “Map” of Feto-infant Mortality:Cluster Analyses • Used the 1995-1997 US fetal death and linked birth & infant death files • Clustered by both underlying cause of death category & maternal risk factors • Used near consensus findings of 8 hierarchal cluster methods: Average, Complete, Centroid, EVM, Flexible, McQuitty, Single, & Ward • Compared results to theoretical model

  22. Developing the “Map” of Feto-infant Mortality Fetal Deaths Early Neonatal Late Neonatal Post neonatal 1 2 3 4 <1000 g 5 6 7 8 1000-1499 g 9 10 11 12 1500-2499 g 13 14 15 16 2500+ g

  23. Developing the “Map” of Feto-infant Mortality Age at Death Neonatal Postneonatal Fetal (24 wks) Birthweight 1 2 3 500-1499 g 4 6 5 1500+ g

  24. Perinatal Periods OfRiskFetal-Infant Mortality Map Fetal Death Post- neonatal Neonatal Maternal Health/ Prematurity 500-1499 g Maternal Care Newborn Care Infant Health 1500+ g

  25. Maternal Health/ Prematurity From Data to Potential Action Preconceptional Health Health Behaviors Perinatal Care Prenatal Care High Risk Referral Obstetric Care Maternal Care Perinatal Management Neonatal Care Pediatric Surgery Newborn Care Sleep Position Breast Feeding Injury Prevention Infant Health

  26. What do we mean by “PPOR Analytic Phases”? • Phase 1:Identifies the populations with overly high numbers and rates of mortality. It examines the 4 components—Maternal Health/ Prematurity, Maternal Care, Newborn Care & Infant Health—for various populations and uses a comparison group to estimate “excess deaths.” • Phase 2:Explains the excess deaths. It examines reasons for the excess deaths through further epidemiologic studies, death reviews, program and policy reviews and other community assessments.

  27. PPOR Phase 1 • Examines the four “Periods of Risk” — Maternal Health/ Prematurity, Maternal Care, Newborn Care & Infant Health — for various population groups • Identifies groups and periods of risk with themost deaths, highest rates. • Uses comparison groups to estimate “excess death”

  28. Phase I ExampleWhat are Phase I Results for Douglas County?

  29. PPOR Map of Fetal-Infant DeathsDouglas County, NE, All Races1997-2000 298 Total Fetal-Infant Deaths Maternal Health/ Prematurity 119 Maternal Care 73 Newborn Care 52 Infant Health 54 28,956 Fetal Deaths & Live Births

  30. How Do We Calculate the Fetal-Infant Mortality Rate?Douglas County, NE, All Races1997-2000

  31. How Do We Calculate the Fetal-Infant Mortality Rate?Douglas County, NE, All Races1997-2000 Numerator Denominator 116Fetal Deaths 24+ wks. 182Infant Deaths 298Fetal-Infant Deaths 116Fetal Deaths 24+ wks. 28,840Live Births 28,956Live Births & Fetal Deaths + + / = 10.3Fetal-Infant Deaths Per 1,000 Live Births & Fetal Deaths

  32. Map of Fetal-Infant Mortality Rates Douglas County, NE, All Races1997-2000 Fetal-Infant Mortality Rate = 298 x 1,000 28,956 = 10.3(4.1 + 2.5 + 1.8 + 1.9) 4.1 2.5 1.8 1.9

  33. 6 Basic Steps: Perinatal Periods of Risk Approach • Bring community partners together to build consensus, support, and partnership. • “Map” fetal & infant deaths by birth weight & age at death. • Focus onunderstanding the overallfetal-infant death rate.

  34. PPOR Map of Fetal-Infant Mortality Douglas County, Nebraska All Races, 1990-2000 Fetal-Infant Rate=11.0 Fetal-Infant Rate=10.7 3.6 Fetal-Infant Rate=10.3 4.0 2.3 1.8 3.3 2.3 1.4 2.9 1990-1992 4.1 1993-1996 2.5 1.8 1.9 1997-2000

  35. PPOR Map of Fetal-Infant Mortality Douglas County, NE, byRace, 1997-2000 WhiteFetal-Infant Rate = 8.9 BlackFetal-Infant Rate =17.9 3.5 7.1 2.4 1.5 1.4 3.2 2.7 4.9 White non-Hispanic Black non-Hispanic

  36. Maternal Health/ Prematurity From Data to Potential Action Preconceptional Health Health Behaviors Perinatal Care Prenatal Care High Risk Referral Obstetric Care Maternal Care Perinatal Management Neonatal Care Pediatric Surgery Newborn Care Sleep Position Breast Feeding Injury Prevention Infant Health

  37. 6 Basic Steps: Perinatal Periods of Risk Approach • Bring community partners together to build consensus, support, and partnership. • “Map” fetal & infant deaths by birth weight & age at death. • Focus on understandingthe overall fetal-infant death rate. • Look for “opportunity gaps” between different groups.

  38. Perinatal Periods of Risk:What is the “Gap”? • ASK: Which women/infants have the "best" outcomes? • ASSUME: all infants can have similar “best” outcomes • CHOOSE: a comparisongroup(s) (‘reference group’) who already has achieved “best” outcomes • COMPARE: fetal-infant mortality rates in your target group with those of the comparison group(s) • CALCULATE:excessdeaths (= target – comparison groups). This is your community’s “Opportunity Gap.”

  39. Which “Comparison Group” should we use?Which women and infants have “best” outcomes?Where should the “bar”be set?

  40. National PPOR Initiative’s “External” Comparison Group • Defined by maternal characteristics • 20 or more years of age • 13 or more years of education • Non-Hispanic white women • 12 U.S. cities with adequate reporting • Low (25th percentile) group-specific death rates Source: NCHS Data, 1995-1997 Calculations by CDC/CityMatCH

  41. National External Comparison Group’sFetal-Infant Mortality Rates 2.2 Total Fetal-Infant Mortality Rate= 5.8 1.5 1.0 1.2 Source: NCHS Data, 1995-1997 Calculations by CDC/CityMatCH

  42. Map of Fetal-Infant Mortality Rates Douglas County, NE, All Races1997-2000 4.1 Total Fetal-Infant Mortality Rate = 10.3 2.5 1.8 1.9

  43. Fetal-Infant Mortality Rates Douglas County, NE vs. External Comparison

  44. ExcessFetal-Infant Mortality Rates Douglas County, NE, 1997-2000 __ =

  45. Fetal-Infant Mortality Rates Douglas County, NE, Total and by Race, 1997-2000

  46. Fetal-Infant Mortality Rates Douglas County, NE, Total and by Race, 1997-2000

  47. ExcessFetal-Infant Mortality RatesDouglas County, NE, 1997-2000

  48. Number of ExcessFetal-Infant DeathsDouglas County, NE, 1997-2000

  49. ExcessFetal-Infant Mortality using External Comparison GroupDouglas County, NE, All Races, 1997-2000 Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Total 131excessdeaths Blacks Whites 49excess Black deaths 65 excessWhite deaths 298 Total Fetal-Infant Deaths

  50. ExcessFetal-Infant Mortality using External Comparison GroupDouglas County, NE, All Races, 1997-2000 Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Total 131excessdeaths Blacks Whites 49excess Black deaths 65excess White deaths 298 Total Fetal-Infant Deaths

More Related