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

4. Feto-Infant Mortality Franklin County, Ohio, All Races 1997-1998 Maternal Health/ Prematurity 123 Maternal Care 71 Newborn Care 43 Infant Health 82 319 Feto- Infant Deaths 32,673 Fetal Deaths & Live Births

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

6. 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.

9. 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?

10. Raising the roof for PPOR: 5 4 3 2 1 2 3 4 5 54325432 2 3 4 5 2 3 4 5 Reasoning Roles Resources Risk/Rewards Results What shape is your tent?

11. 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

12. 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

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

15. Birth Versus Death Cohort Birth Cohort Births Deaths 19992000 Death Cohort Births Deaths 19992000

16. 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

18. 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

27. Feto-Infant Mortality Franklin County, Ohio, All Races 1997-1998 Maternal Health/ Prematurity 123 Maternal Care 71 Newborn Care 43 Infant Health 82 319 Feto- Infant Deaths 32,673 Fetal Deaths & Live Births

28. Feto-Infant Mortality Rates Franklin County, Ohio, All Races 1997-1998 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

29. Excess Feto-Infant Mortality Franklin County, Ohio, 1997-1998 - = Franklin Co. All Races U.S. Reference Excess 3.8 2.21.32.5 9.8 2.2 1.51.01.2 5.8 1.6 0.70.31.3 4.0

30. Feto-Infant Mortality Rates Franklin County, Ohio, Black 1997-1998 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

31. Excess Black Feto-Infant Mortality Franklin County, Ohio, 1997-1998 - = Franklin Co. Black U.S. Reference Excess 5.8 3.81.65.5 16.7 2.2 1.51.01.2 5.8 3.6 2.30.64.3 10.9

32. Excess Feto-Infant Mortality Overall and Black Franklin County, Ohio, 1997-1998 Franklin County Overall Excess Black Excess 1.6 0.70.31.3 3.6 2.30.64.3

33. Infant Health – Phase II Franklin County, 1997-98 Postneonatal deaths of birth weight of 1500 grams or above

34. Prevalence of Selected Risk Factors Franklin County, 1997-98 *Postneonatal deaths of birth weight of 1500 grams or above

35. 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

36. 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

37. 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

38. 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

39. 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

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

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

42. For Further Information, visit the CityMatCH website: www.citymatch.org