The Perinatal Periods of Risk Approach Ten Things You Should Know Jennifer Skala, MEd CityMatCH 2003 Healthy Start Grantee Meeting

Improving the health and well-being of urban women, children and families by strengthening public health organizations and leaders in their communities. CityMatCH Mission

CityMatCH PPOR Activities To develop and advance the practice of the PPOR approach as a community tool to improve the health of women and infants To develop and advance the practice of the PPOR approach as a community tool to improve the health of women and infants

The PPOR Urban Learning Network To strengthen local public health capacity for improving perinatal health through the effective use of the PPOR approach. How to Do PPOR workshopsHow to Do PPOR workshops Distance SeminarsDistance Seminars Technical AssistanceTechnical Assistance Peer ExchangePeer Exchange

10 Things You Should Know about the PPOR Approach

1)PPOR is a comprehensive approach used to address feto-infant mortality PPOR analysis is the starting point not the ending point

2) The PPOR Data allow you to look at feto-infant mortality in new ways  Includes Fetal and Infant Deaths (  Includes Fetal and Infant Deaths ( > 24 weeks)  Focuses on VLBW (< 1,500 grams)  Generates a “Map” for targeting strategic actions  Examines birthweight and gestational age at the same time

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

PPOR “Map” fetal & infant deaths PPOR “Map” fetal & infant deaths g g Fetal Death Neonatal Post- neonatal Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Birthweight Age at Death

3) It brings community partners together to build consensus, support, and partnership Provides a framework for discussing the problem

4) It allows a Community to move toward Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Preconceptional Health Health Behaviors Perinatal Care Prenatal Care High Risk Referral Obstetric Care Perinatal Management Neonatal Care Pediatric Surgery Sleep Position Breast Feeding Injury Prevention ACTION!

5) It’s more than rates and numbers, it allows a community to focus on the Gaps: ASK: Which women/infants have the "best" outcomes? ASSUME: all infants can have similar “best” outcomes CHOOSE: a comparison group(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: excess deaths (= target – comparison groups). This is your community’s “Opportunity Gap.”

6) PPOR provides a framework for targeting further investigations and actions Phase 1: Identifies the populations with overly high numbers and rates of mortality. Phase 1: Identifies the populations with overly high numbers and rates of mortality. Phase 2: Explains why the excess deaths. Phase 2: Explains why the excess deaths.

Where and Why the excess deaths? Women’s Health vs. NICU survival Causes of Death Infant Health Maternal Health/ Prematurity

7) PPOR Fosters integration with other key efforts Previous assessmentsPrevious assessments Previous perinatal studies or surveillancePrevious perinatal studies or surveillance Mortality ReviewsMortality Reviews PRAMS or other surveysPRAMS or other surveys Health system assessmentsHealth system assessments Asset mappingAsset mapping Previous policy and program evaluationsPrevious policy and program evaluations “Paint the faces behind the numbers”

Critical Integration Fetal and Infant Mortality Reviews Local Health Action Plan Perinatal Periods of Risk

8) You need to be ready analytically to do the PPOR approach Fetal death files (no gest. age restrictions) Fetal death files (no gest. age restrictions) Linked birth—infant death certificate files Linked birth—infant death certificate files Unlinked infant death certificate files Unlinked infant death certificate files Key data items missing or poor quality Key data items missing or poor quality

9) You need the Community Onboard and Ready Champions, Leadership and Adequately Trained Staff that: Understands the feto-infant mortality problem Understands the feto-infant mortality problem Understands the work plan Understands the work plan Commits to providing resources for the investigation Commits to providing resources for the investigation Commits to providing resources for community collaboration Commits to providing resources for community collaboration Gives priority and champions the initiative Gives priority and champions the initiative

Builds data and epi capacity Builds data and epi capacity Promotes effective data use Promotes effective data use Strengthens essential partnerships Strengthens essential partnerships Fosters integration with other key efforts Fosters integration with other key efforts Encourages evidence-based interventions Encourages evidence-based interventions Helps leverage resources Helps leverage resources Enables systems change for perinatal health Enables systems change for perinatal health PPOR is about impact and results: 10) PPOR is about impact and results:

Headline News… Locally-defined disparities serve to target further investigations and tailor prevention Philadelphia PA Successful integration of PPOR, FIMR, Healthy Start yields better prevention of feto-infant deaths Louisville KY Stronger local/state partnership builds better data capacity to address health disparities Columbus OH

Headline News… PPOR Reenergized the Community to Prioritize Actions Pittsburgh, PA Using PPOR and FIMR to Focus Efforts and Resources Jacksonville FL

10 Things You Should Know: 1. PPOR is a comprehensive approach used to address feto-infant mortality 2. The PPOR Data allow you to look at feto-infant mortality in new ways 3. It brings community partners together to build consensus, support, and partnership 4. It allows a Community to move toward ACTION! 5. It’s more than rates and numbers, it allows a community to focus on the Gaps 6. PPOR provides a framework for targeting further investigations and actions 7. PPOR Fosters integration with other key efforts 8. You need to be ready analytically to do the PPOR approach 9. You need the Community to be Ready to do the PPOR approach 10. PPOR is about impact and results

P erinatal P eriods o f R isk: For More Information: “How to Do” PPOR workshop Dec 12 and 13 In conjunction with MCH EPI Conference in Tempe, AZ