P erinatal P eriods o f R isk Analytic Readiness Bill Sappenfield A CityMatCH “How-to-Do” Workshop

“If you don’t know where you are going, there are many ways to get there…” Old African Proverb

PPOR Conceptual Framework

Improve Maternal & Infant Health Seeing the “Big Picture”

Seeing the “Big” Picture Planning Cycle Assessment Perinatal Periods of Risk

Big Picture Planning Cycle Community readiness and investment Stakeholders Vision Planning process Resources available or planned Timeframe Accountability

Community Assessment Previous assessments Previous perinatal studies or surveillance Fetal and infant mortality reviews PRAMS or other surveys Health system assessments Asset mapping Previous policy and program evaluations Decision-making process

Analytic Readiness: What Does it Mean?

PPOR Analytic Readiness: What does it means? Data access/quality Minimum number of events Adequately trained analytic staff Adequately trained communication staff Analysis team including program staff Sufficient staff hours Strong leadership agreement & support

Direct Data Access/Quality? Fetal death files (no gest. age restrictions) Linked birth—infant death certificate files Unlinked infant death certificate files Key data items missing or poor quality Gestational age Birthweight Education Race/Ethnicity

PPOR Minimum? Overall, and every subpopulation or geographic region needs roughly 60 feto- infant deaths to have sufficient numbers to calculate rates.

Adequately Trained Analytic Staff? Analyze large data files Familiarity with birth and death files Assess data quality and reporting Calculate and compare rates Estimate confidence limits and p-values Investigate causes and risk factors Conduct multivariate analysis Summarize analytic findings Understand perinatal health issues

Adequately Trained Communication Staff? Determine Single Overriding Communication Objective Develop compelling messages Condense numbers and figures Write reports and fact sheets Produce graphic presentations Tailor communications to the audience

Analysis Team? Data analyst Policymaker or staff Program or content specialist Clinical specialist Vital records specialist Communication expertise

Sufficient Staff Hours for Both Phases? Preparation Phase 1 analysis Phase 2 analyses Communication preparation Participation in dissemination and follow up

Strong Leadership Agreement & Support? Understands the feto-infant mortality problem Understands the work plan Commits to providing resources for the investigation Commits to providing resources for community collaboration Gives priority and champions the initiative

PPOR Analytic Readiness: What does it mean?  Data access/quality  Minimum number of events  Adequately trained analytic staff  Adequately trained communication staff  Analysis team including program staff  Sufficient staff hours  Strong leadership agreement & support

PPOR Analytic Readiness: What does it mean?  Data access/quality  Minimum number of events  Adequately trained analytic staff  Adequately trained communication staff  Analysis team including program staff  Sufficient staff hours  Strong leadership agreement & support       

Ready, Aim, and Fire!