MATERNAL FETAL Population health module

1. MATERNAL FETAL Population health module Integrating Population Health Inquiry Transforms (IPHIT) Family Medicine Belleville Education Afternoon December 18, 2013

2. Objectives • We will review what outcome measures (metrics) to consider applying • We will review maternal fetal health population health data and try to drill down to a clinic level and consider health disparities • We will look at some sample financial data as it relates to some of our inquiry today

3. Where to go when everything seems interesting?

4. What are health insurers measuring? • HEDIS (Healthcare Effectiveness Data and Information Set) is a tool used by more than 90% of U.S. health plans to measure performance. It consists of 75 measures across 8 domains of care allowing comparison of health plans on an “apples-to-apples” basis. • 8 Domains: • Effectiveness of Care • Access/availability of Care • Satisfaction with the Experience of Care Provided • Health Plan Stability • Use of Service • Cost of Care • Informed Health Care Choices • Health Plan Information is Clear and Descriptive

5. Here is what HEDIS currently measures for OB care:

6. But as you can see other parameters need to be defined to answer what seems like a simple question: e.g. time frame, billing codes, etc.

7. Healthy People • National agenda that communicates a vision and overarching goals, supported by topic areas and specific objectives for improving the population’s health and achieving health equity. • The overarching goal of Healthy People 2020 is to attain high quality, long lives free of preventable disease, with a reduction in premature death and the second goal to achieve health equity, eliminating disparities and improving the health of all groups. Slade-Sawyer, P, HHS Office of Disease Prevention and Health Promotion

8. Evolution of Healthy People *39 Topic areas with objectives Slade-Sawyer, P, HHS Office of Disease Prevention and Health Promotion

9. 2020 Maternal INFANt CHILD health metrics Some examples

10. Morbidity and Mortality • MICH-7 Reduce cesarean births among low-risk (full-term, singleton, and vertex presentation) women • MICH-7.1 Reduce cesarean births among low-risk women with no prior cesarean births • Baseline: 26.5% of low-risk females with no prior cesarean birth had a cesarean birth in 2007 • Target: 23.9% (10% improvement) • MICH-7.2 MICH-7.2 Reduce cesarean births among low-risk women giving birth with a prior cesarean birth • Baseline: 90.8% of low-risk females giving birth with a prior cesarean birth had a cesarean birth in 2007 • Target: 81.7% (10% improvement) • Data Source: National Vital Statistics System-Natality (NVSS-N), CDC/NCHS

11. Morbidity and Mortality • MICH-1.3 Reduce the rate of all infant deaths • ★ Leading Health Indicator ★ • Baseline (2006): 6.7 infant deaths per 1000 live births • Target: 6.0 infant deaths per 1000 live births (10% improvement) • MICH-1.1: Reduce the rate of fetal deaths at 20 or more weeks of gestation • MICH-1.2: Reduce the rate of fetal and infant deaths during perinatal period (28 wks gestation-7 days after birth) • MICH-1.4: Reduce the rate of neonatal deaths (within the first 28 days of life) • MICH-1.5: Reduce the rate of postneonatal deaths (between 28 days and 1 year of life)

12. Reduce total preterm births • MICH-9.1 Reduce total preterm births • ★ Leading Health Indicator ★ • Baseline (2007): 12.7% of live births were preterm • Target: 11.4% (10% improvement)

13. Pregnancy Health and Behaviors • MICH-10.1 Increase the proportion of pregnant women who receive prenatal care beginning in first trimester • Baseline: 70.8% of females delivering a live birth received prenatal care beginning in the first trimester in 2007 • Target: 77.9% (10% improvement) • MICH-11.1 Increase abstinence from alcohol among pregnant women • Baseline: 89.4% of pregnant females aged 15 to 44 years reported abstaining from alcohol in the past 30 days in 2007–08 • Target: 98.3 % (10% improvement) • MICH-11.3 Increase abstinence from cigarette smoking among pregnant women • Baseline: 89.6% of females delivering a live birth reported abstaining from smoking cigarettes during pregnancy in 2007 • Target: 98.6% (10% improvement) • MICH-11.4 Increase abstinence from illicit drugs among pregnant women • Baseline: 94.8% pregnant females aged 15 to 44 years reported abstaining from illicit drugs in the past 30 days in 2007–08 • Target: 100 percent (Total coverage) • MICH-13 (Developmental) Increase the proportion of mothers who achieve a recommended weight gain during their pregnancies • Data Source: Data Source: National Vital Statistics System-Natality (NVSS-N), CDC/NCHS ; National Survey on Drug Use and Health (NSDUH), SAMHSA (for MICH 11.4 only)

14. Other categories • Preconception health and behaviors: • Examples • MICH-16.3: Increase the proportion of women* who did not smoke prior to pregnancy • MICH-16.5: Increase the proportion of women who had a healthy weight prior to pregnancy • Postpartum health and behavior • Examples • MICH-18: Reduce postpartum relapse of smoking • MICH-19: Increase the proportion of women who attend a postpartum visit with a health care worker • Infant care • Example • MICH-21.1 Increase the proportion of infants who are ever breastfed

15. National and STATE Data National Vital Statistics Report Volume 62, Number 1. June 28, 2013.

16. Pregnancy rates

17. Teen pregnancy rates

18. Cesarean delivery rates

19. Infant mortality rates

23. The Black-White infant mortality ratio is persistent (2.3 in 1990 vs. 2.4 in 2000)

24. It’s not just early prenatal care Odds ratio for perinatal mortality >35,000 pregnancies followed – all had early prenatal care

25. Preterm birth rates

27. State data examples

28. Cesarean sections

29. Infant mortality

32. Premature Births

33. Smoking during pregnancy

34. Local data

36. What maternal-fetal metrics is Healthydane.org measuring?

38. Mothers who smoked during pregnancy • The Healthy People 2020 national health target is to decrease the percentage of women who gave birth and who smoked cigarettes during pregnancy to 1.4%.

39. Mothers who smoked during pregnancy

40. Mothers who smoked during pregnancy

41. Local Hospital data Wisconsin Collaborative for Healthcare Quality (WCHQ)

42. St. Mary’s did not report birth measures data

43. BellevilleCLINIC and UW- Madison family medicine residency clinics This data reflects deliveries in 2010-2013 where the prenatal care was provided by our residency DFM clinics.

44. Belleville: Cesarean section rates • Our cesarean section rate is 14% • Northeast is 11% • Verona is 13% • Wingra is 14% • 2020 Healthy People • MICH-7 Reduce cesarean births among low-risk (full-term, singleton, and vertex presentation) women • MICH-7.1 Reduce cesarean births among low-risk women with no prior cesarean births • Baseline: 26.5% of low-risk females with no prior cesarean birth had a cesarean birth in 2007 • Target: 23.9%

46. This is an interesting trend but notably for NE n=14 95% CI [5,51]; Wingra n=93 95% CI [7,22]; not statistically significant.

47. Belleville: Pregnancy smoking rates • Our pregnancy smoking rate is 18% • Northeast is 17% • Verona is 11% • Wingra is 18% • 2020 Healthy People MICH-11.3 Increase abstinence from cigarette smoking among pregnant women • Baseline: 89.6% of females delivering a live birth reported abstaining from smoking cigarettes during pregnancy in 2007 • Target: 98.6% (i.e.1.4% smoking rate)

50. Belleville: Pregravid obesity rates • Our pregravid obesity rate is 30%; excessive weight gain rate is 57% • Northeast is 26%; 47% respectively • Verona is 16%; 65% • Wingra is 26%; 38% • This data is more limited as it requires the clinician to input the pre-pregnancy weight