1. MCHB Programs In Support of the Preemie Act Hani K
MCHB Programs In Support of the Preemie Act Hani K. Atrash MD, MPH Director Division of Healthy Start and Perinatal Services (DHSPS) Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) Meeting of the Secretary’s Advisory Committee on Infant Mortality, August 10-11, 2015 Washington, DC

2. The PREEMIE Reauthorization Act
Reauthorizes… the Secretary of HHS to conduct demonstration projects related to preterm births …. to test and evaluate various strategies .. on:
(1) the core risk factors for preterm labor and delivery,
(2) medically indicated deliveries before full term,
(3) the importance of preconception and prenatal care,
(4) treatments and outcomes for premature infants,
(5) meeting the informational needs of families during the stay of an infant in a neonatal intensive care unit, and
(6) utilization of evidence-based strategies to prevent birth injuries.

3. Preconception / Interconception health Life-course approach
HRSA Approaches to Improving Pregnancy Outcomes
Preconception / Interconception health
Life-course approach
Collaborative Innovation Networks (COINS)
Collective impact
Backbone organizations

4. Improving Pregnancy Outcomes – Levels of Support
National:
Secretary’s Advisory Committee on Infant Mortality (SACIM)
National Maternal Health Initiative
Guidelines for Well Woman Care
Title V Transformation / Collaborative Improvement and Innovation Network (COIN)
State/Regional:
Maternal, Infant and Early Childhood Home Visiting
Local/Community:
National Healthy Start Program

5. MCHB supports SACIM’s National Strategy to Reduce Infant Mortality: the 6 Big Ideas (1/2013)
Improve the health of women
Ensure access to a continuum of safe and high quality, patient-centered care
Redeploy key evidence-based, highly effective preventive interventions to a new generation
Increase health equity and reduce disparities by targeting social determinants of health through investments in high-risk communities and initiatives to address poverty.
Invest in adequate data, monitoring, and surveillance systems to measure access, quality, and outcomes.
Maximize the potential of interagency, public-private, and multi-disciplinary collaboration.

6. Title V Block Grant Transformation
Reduce burden
Reducing data reporting by prepopulating from federal sources
Simplifying/clarifying and reducing the number of forms; streamlining narrative and application
Maintain flexibility
Choice in national performance measures (8 of 15)
State-specific performance measures (3 to 5)
State-developed evidence-based/informed strategy measures
Improve accountability and document impact
Fewer performance measures directly tied to Title V activities
New framework that tracks performance in relation to activities

7. Performance Measure Domains
Women’s / Maternal Health
Perinatal/Infant Health
Child Health
Adolescent Health
CSHCN
Cross-cutting / Life Course

8. Title V Performance Measures Related to Prematurity
Well Woman Visit: Past-year preventive visit among women ages (%) (PM 1)
Low-risk Cesarean: Cesarean among nulliparous, term, singleton, vertex live births (%) (PM 2)
Adolescent Well Visit: Past-year preventive visit among adolescents ages (%) (PM 4)
Smoking during pregnancy (%) (PM 14 A)

9. Title V Outcome Measures Related to Prematurity
First trimester prenatal care entry
Severe maternal morbidity
Infant outcomes: Preterm birth  (<37 weeks gestation); Early preterm birth (<34 weeks gestation); Late preterm birth (34-36 weeks gestation); and, Early term birth (37,38 weeks gestation)
Early elective deliveries (37, 38 weeks gestation)
Mortality (infant): Perinatal mortality rate; Infant mortality rate; Neonatal mortality rate; and, Preterm-related mortality rate

10. Women’s Health Preventive Services Guidelines for Well Women Care
Support the development of clinical preventive health guidelines for well woman visit
Compile the guidelines into a succinct resource
Disseminate these guidelines and promote their adoption into standard clinical practice among women’s health care providers

11. National Maternal Health Initiative
Goal: Promote coordination and collaboration within HRSA, across HHS agencies and with professional and private organizations.
Priorities:
Improving women’s health before, during, and after pregnancy
Improving systems of maternity care including clinical and public health systems
Improving public awareness and education
Improving research and surveillance
Improving the quality and safety of maternity care

12. National Maternal Health Initiative Alliance for Innovation on Maternal Health (AIM)
A four year $4 million cooperative agreement with the “Council on Patient Safety in Women’s Health Care” supported by the American Congress of Obstetricians and Gynecologists (ACOG)
Goal: to prevent 100,000 severe complications during delivery hospitalizations and 1,000 maternal deaths by 2018
Approach: the development and rollout of evidence-based patient-safety bundles

13. National Maternal Health Initiative Alliance for Innovation on Maternal Health (AIM)
Supports harmonized data-driven continuous quality improvement processes
Provides evidence-based implementation resources to streamline bundle implementation
Leadership team, in addition to ACOG, includes more than 25 organizations and agencies
Continuous quality improvement efforts are data driven

14. National Maternal Health Initiative Alliance for Innovation on Maternal Health (AIM)
Safety bundles include:
Obstetrical Hemorrhage
Severe Hypertension/Preeclampsia
Prevention of Venous Thromboembolism
Support for Intended Vaginal Birth
Reduction of Peripartum Racial Disparities
Standards of Care for the Interconception/Postpartum Visit
AIM facilitates multidisciplinary and interagency collaboration between states and hospitals

15. The Infant Mortality CoIIN The Collaborative Improvement & Innovation Network to Reduce Infant Mortality
Designed to help States innovate and improve their approaches to improving birth outcomes
Initiated March 2012 as a mechanism to support the adoption of collaborative learning and quality improvement principles and practices to reduce infant mortality and improve birth outcomes

16. Regions IV and VI CoIIN: Strategies & Structure
5 Strategy Teams
Reducing elective deliveries <39 weeks (ED);
Expanding interconception care in Medicaid (IC);
Reducing SIDS/SUID (SS);
Increasing smoking cessation among pregnant women (SC);
Enhancing perinatal regionalization (RS).
Teams
2-3 Leads (Content Experts);
Method Experts
Data Experts
Shared Workspace
Data Dashboard

17. Non-Medically Indicated Early Term Deliveries Among Singleton, Term Deliveries*
30% total decline translating to ~85,000 early elective deliveries averted since 2011 Q1
5 states met aim of 33% reduction
11 states had declines of 20%+
* Based provisional birth certificate data; denominator excludes women
with medical indications present prior to and during pregnancy

18. Smoking During Pregnancy*
12% total decline translating to ~18,000 fewer women smoking in pregnancy since 2011 Q1
6 states met aim of 3% reduction
* Based on provisional birth certificate data reflecting smoking in any trimester

19. National CoIIN 58 States & Jurisdictions 6 Strategy Teams Safe sleep
Smoking Cessation
Social Determinants
Preconception/Interconception Care
Prevention of Preterm and Early-Term Births
Perinatal Regionalization 19

20. Preconception/Interconception Health n=29
LEGEND
Learning Network Chosen =
Puerto Rico

21. Prevention of Preterm & Early Term Births n=21(Progestogens & EED)
LEGEND
Learning Network Chosen =
Puerto Rico

22. Perinatal Regionalization n=14
LEGEND
Learning Network Chosen =
Puerto Rico

23. Smoking Cessation n=21
LEGEND
Learning Network Chosen =
Puerto Rico

24. Social Determinants of Health n=23
LEGEND
Learning Network Chosen =
Puerto Rico

25. THE NATIONAL HEALTHY START PROGRAM
History
Established in 1991 as a presidential initiative
Provides funding and supports communities with high infant mortality rates and other adverse perinatal outcomes
Focused on community innovation and creativity and encouraged communities to do what was best for them
Today, HRSA supports 100 healthy start projects in 37 States and Washington, DC 25

26. Main Changes to Healthy Start Healthy Start Approaches
Improve Women’s Health
Promote Quality Services
Strengthen Family Resilience
Achieve Collective Impact
Increase Accountability through Quality Improvement, Performance Monitoring, and Evaluation

27. The Federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)
Provide voluntary, evidence-based home visiting services to pregnant women and families with young children
Budget grew from $100 million in 2010 to $400 million in 2014
In 2014, MIECHV supported 685 unique Local Implementing Agencies (LIAs) serving 115,500 parents and children in 787 counties in 50 states, DC and 5 territories
The program reaches those at the highest need (79% below poverty level, 34% of adults had less than high school education, and 67% were racial and ethnic minorities)

28. The Federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)
8 of the 17 evidence-based models target pregnant women:
Early Head Start
Early Intervention Program for Adolescent Mothers
Healthy Families America
Maternal Early Childhood Sustained Home Visiting Program
Minding the Baby
Nurse Family Partnership
Oklahoma’s Community-Based Family Resource and Support Program
Parents as Teachers
In 2014, 27% of newly enrolled households included pregnant teenagers

29. For More Information Hani Atrash, MD, MPH Director, DHSPS
5600 Fishers Lane, Room 13-91
Rockville, MD 20857
Office:
Direct: