1. Secretary’s Advisory Committee on Infant Mortality November 14, 2012 David Lakey, M.D. Commissioner Texas Department of State Health Services

2. Maternal Care Newborn Care Infant Health Maternal Health/ Prematurity Preconception Health Health Behaviors Perinatal Care Prenatal Care High Risk Referral Obstetric Care Perinatal Management Neonatal Care Pediatric Surgery Safe Sleep Breast Feeding Injury Prevention 2 Possible Points for Intervention

3. WhiteBlackHispanic 1990 2010 Adult Obesity in Texas (1990 vs. 2010) 3

4. Texas Women Fail to Meet Healthy People 2020 Prenatal Care Goal 4

5. Almost Half of Black Women in Texas – No First Trimester Prenatal Care 5

6. Inductions Have Increased Steadily in Texas and the US 6

7. Elective Inductions Increase Prematurity and C-Section Rates In 2010, 1 in 4 deliveries were induced in Texas Induction rates increased by 40% in Texas between 2000-2010 In 2010, 38.4% of single-birth inductions were performed before 39 weeks of gestation Labor induction is associated with an increased risk of delivery by cesarean section (C-section) 7

8. Preventing Infant Mortality through Regionalization of Perinatal Services Very low birth weight (VLBW) infants –Represent less than 2% of US births –Account for 55% of infant deaths Levels of perinatal care (I, II, & III) –Level III facilities have the ability to care for very low birth weight infants. –VLBW infants not born in a level III hospital are more likely to die. HP 2010 goal: 90% of all VLBW infants are born in level III hospitals –Only met by 5 states –10 states (including TX) are below 70% 8

9. Healthy Texas Babies Healthy Texas Babies (HTB) is an initiative to decrease infant mortality in Texas Goals of Healthy Texas Babies Initiative: – Provide local partnerships and coalitions with major roles in shaping programs in their communities – Use evidence-based interventions – Decrease preterm birth rate by 8% over 2 years – Save ~ $7.2 million in Medicaid costs over 2 years 9

10. Legislation to eliminate Medicaid payment for elective inductions/C-sections <39 weeks Outreach campaign to promote father’s involvement with children before birth Council created to study neonatal intensive care unit regionalization $4.1 million General Revenue appropriated for this effort Healthy Texas Babies 93

11. HTB Local Coalitions Eleven Local Coalitions  Evidence-based projects  Broad-based Membership  December 2011- August 2013  $200K contracts awarded to each of the 11 local coalitions 11

12. DSHS Local Coalition Initiatives Corpus Christi – Preconception Diabetes Management Dallas – Feto-Infant Mortality Review Board El Paso – Enhanced identification of high-risk pregnancies Fort Worth – Fatherhood Mentoring for Teen Dads Galveston – Mother-Friendly Worksite – Breastfeeding Houston – Pre- and Inter-conception Wellness Laredo – Media Campaign on Perinatal Health Longview – Centering Pregnancy ® Lubbock – Stork’s Nest ® San Antonio – HOPES Project: Case Management for Mothers with Previous Poor Birth Outcomes Waco – Healthy Babies are Worth the Wait ® 12

13. “Someday Starts Now” 13

14. “Someday Starts Now” 14

15. “Protect Two From the Flu” 15

16. 16

17. 17 2009 2010 2011 2012 Year

18. Texas Pre-Term Birth Rates 18

19. ASTHO Presidents Challenge 2012: Healthy Babies Goal: Improve birth outcomes by reducing infant mortality and prematurity in the United States. Overall Objectives: 1. Focus on improving birth outcomes as SHOs and state leadership teams work with state partners on health and community system changes. 2. Create a unified message that builds on the best practices from around the nation and the efforts from Regions IV and VI, which can be adopted by states, U.S. territories, and the District of Columbia. 3. Develop clear measurements to evaluate targeted outreach, progress, and return on investment. 19

20. ASTHO President’s Challenge Pledge to Reduce Prematurity by 8% by 2014 20

21. State Strategies to Improve Birth Outcomes Reduce early elective deliveries <39 weeks Access to preconception/ interconception care Smoking cessation Preventing SIDS Improve perinatal regionalization Expand access to 17-P

22. Reduce Elective Deliveries <39 Weeks Louisiana – Louisiana Birth Outcomes Initiative Texas – House Bill 1983 West Virginia – Universal Maternal Risk Screening Program Indiana – 40 Weeks of Pregnancy, Every Week Counts Provider Toolkit Kentucky- Healthy Babies are Worth the Wait

23. Oklahoma - Every Week Counts Began recruiting hospitals for voluntary “hard stop” effort in January 2011 Currently have 52 of 59 birthing hospitals enrolled (88%) Have seen 70% reduction in rate of induction <39 weeks without medical indication

24. 24 % 70 % 7.2 %

25. Georgia – expanded Section 1115 Medicaid waiver Oregon – Innovative Reproductive Health Program combines Title X and Medicaid family planning waiver programs South Carolina – Campaign to Prevent Teen Pregnancy website California – The Interconception Care Project Access to Preconception, Interconception Care

26. Colorado – Colorado QuitLine, a free program for pregnant women Oklahoma – practice facilitation model in obstetric care settings; SoonerQuit statewide media campaign North Carolina – You Quit Two Quit Project Massachusetts – QuitWorks referral program Michigan – free quitline counseling for uninsured or Medicaid enrollees Smoking Cessation

27. Georgia – Crib Matching Program through SIDS Injury Prevention Program Maryland – B’more Babies Safe Sleep Campaign Preventing SIDS

28. New York – Regional Perinatal Center (RPC) leads and coordinates affiliated hospitals Tennessee – Perinatal Advisory Committee; five statewide centers provide 24-hour consultation and referral Improve Perinatal Regionalization

29. North Carolina – 17-P is part of the Pregnancy Medical Home program Louisiana – 17-P Louisiana Resource Center Expand Access to 17- Hydroxyprogesterone (17-P)

30. Thank You! 30