AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
KAREN HUGHES: Good morning, everyone. Okay. Well, you're going to hear about the Ohio story and the Florida story and I can't imagine there's anybody in the room who doesn't know where Florida is. But just in case you didn't know where Ohio is, it is in the Heartland. And Columbus is the capital. And Columbus is just about in the center of the state. It's a beautiful shot of our downtown Skyline. And I want to talk about how the PPOR journey continued from the Columbus health department, which is where it started and Carolyn gave you a very good description of how all of the work they've been doing in Columbus. And when Carolyn came back from the City Match meeting and said I have this new idea about how to analyze birth and death data to do some more, to take it to better steps of action to make a bigger difference in the infant mortality rates in this state, I knew there was something behind it, because what you probably haven't heard already is that Carolyn is also a national leader in City Match. She's one of the recent presidents of the association. So our connection has been strong for many years.
So from the Columbus Health Department, the journey began and he with came to the state health department. And from the state health department or at the state health department we wrestled with not only the challenges of doing PPOR analysis, but also all of the data issues that Carolyn brought to your attention about missing data across the state, about the lack of matched birth and death data and the like. So we had those challenges to work on.
And then we looked at so where are we going to take this journey from the state health department? Where is our best avenue for utilizing the methodology across the state? And we fund with our Title V dollars regional perinatal centers. Many of you also do. And we have six regional perinatal centers in the state of Ohio and they have previously been very focused on the neonatal period of reproductive health. And what we wanted to do was see if there is a way to mobilize that group of folks to address fetal and infant mortality in a different way. So we engaged the regional perinatal centers and brought them along to also involve the urban health departments. And Carolyn at the Columbus Health Department has been tremendously active in City Match but other urban areas in the state of Ohio had not. So this was a new opportunity to gather up the hospitals and the regional perinatal centers and sort of a forced marriage between the hospitals in those regional areas and the urban health departments, but many of those marriages are surviving. And we brought them all together to form what we call a perinatal data use consortium, and that was our way of bringing the resources from the six urban areas across the state on an ongoing basis. One of the major points of this whole presentation is that this is not a data analysis project. This isn't something that you do and you produce a nice report and maybe you share it with a few people and then you move on to the rest of your work. This is, it really is a journey, and it's something that we are continuing to work on in the state of Ohio . So the six regional perinatal centers all have become very active. And quite frankly, we've had varying degrees of success with engaging each of the regional perinatal centers. But they all have significant actions that they've taken already.
I want to draw to your attention who the perinatal data use consortium members are. And those are each regional perinatal center was required to bring to the table a group from their region. And they could draw from the folks in the regional perinatal center, the other hospitals in their region, the urban health departments and the other local health departments in their region, members of ACOG and the Ohio section and Help Me Grow is our birth to three program, and they engaged the community members from Help Me Grow and some of them also involve their families and children first members which is many of you have similar groups at the community level came from a National Governor's Association meeting and I think we all have some organization of groups at the community level that look at children's issues across the span.
So when we started working with our regional perinatal centers, and actually as we started to do this whole process, we recognized that clearly we couldn't do it alone. And we knew that through Carolyn and City Match that there were some experts across the country who had significant experience in doing this and we engaged their assistance. So Kay Johnson is in the room. And Kay was our leader, we contracted with Kay to organize a faculty to bring to the state of Ohio that included George Little, a neonatologist from Dartmouth, and Magda Peck, many of you know, Bill Sappenfield from CDC, as well as Carolyn, who participated as a faculty member.
We organized the groups and we conducted trainings of those teams from the regional centers. We conducted team building exercises. We provided technical assistance calls over a time period. And all of that was to reshape the role and the activities of the regional perinatal centers. And this is probably one of the, what's different about Ohio's approach from other state approaches that much of it has been in the urban health departments and the opportunity that we saw was to also engage our regional perinatal centers. So we have refined their role. Actually, we've done some major revision of their role and we did this through changing the grants that we put out to the regional perinatal centers. We clarified that their purpose is performance monitoring. So they have maternal and child health Bloc grant and other indicators that they use to monitor the performance of perinatal quality of care in their region. And they also address, in an ongoing way, the perinatal quality improvement. That part we're still working on, on how to best utilize the resources at the hospital to monitor the data and engage the other hospitals and other healthcare providers in the entire region to improve the quality of perinatal care.
We've changed their role. They had somewhat evolved into conductors of continuing education for hospital healthcare providers. And we saw this as a new opportunity for them to be active in a broader way. So they are charged with being conveners of groups of people to utilize data in a different way. And, again, the theme that you're going to hear this morning is how the perinatal periods of risk strategy is a conversation starter and it's a way to bring different groups of people together because it's not looking at the traditional trend lines of fetal and infant mortality but rather a new way of looking at the information and thinking it through.
We're also asking them to be catalysts to not conduct interventions in and of their own but rather to get groups in their areas to see if they have resources and they're doing activities now but those activities could be redirected to better address the issues that evolve from the perinatal periods of risk analysis, then we'll have a better chance of making a difference.
So overall their role now is to advance data knowledge and improve the quality of perinatal practices across systems within their regions.
So I couldn't leave you without sharing just a little bit of our data, and I don't share these slides necessarily for you to take away the numbers, but I think what's interesting about this is what, as you do this analysis at one level, it triggers so many more questions and gives you impetus to look at it among different population groups. So this was the first level of analysis at looking as you heard about the reference group, which is the darker bar in each color category across the graph, and then the lighter bar is the rest of the fetal and infant deaths across the state.
So this was the whole state, all births. Then when we looked at the African American births, because in the state of Ohio not unlike the nation, our disparities are significant and disturbing.
So we looked at the African American population. Then we started to take this out and talk to people. And one of the conversations we had was with our assistant director and director of health at the state health department. And one of the questions back was well what about the teams? And while many of us across the country have become quite pleased with our decreasing rates of births to teens, what we hadn't looked at very recently was what are the outcomes of those births, and look at how the bars start to grow. And then when we looked at the African American teams, the bars get even taller. So this triggered us to have, again, new and different conversations with different groups. So we saw opportunities for coordinated program efforts and similar to every country in the United States , in every state in the United States , in the country, you all have these programs that offer services to similar populations of families.
So we had our Title V maternal and child health programs that could clearly do things to better focus efforts on the populations that are suffering disproportionately.
Our family planning program, as Carolyn mentioned, we refined the scope of services within family planning and tried to direct more of their attention to the preconception and interconception health periods. Our birth to three program, we saw opportunities for adding to their focus, recognizing that the birth to three programs are very attentive when the baby is born and they provide a tremendous cadre of services for the infant, but often we forget about the mother's health, and once we know that a mother has delivered a low birth weight baby, she's at much greater risk, as you know, for delivering a second low birth weight infant. So we're looking for opportunities to wrap ourselves around women who have already delivered a preterm birth, and help her to become healthy before a second pregnancy.
Our regional perinatal centers, I described to you their involvement. Our WIC program we've engaged as well they've been interested in how better to focus their outreach efforts on individuals in the categories that we talked about. And our Medicaid program has gained interest, and we're trying to encourage our Medicaid program to do a similar analysis among women whose care is paid for by Medicaid. One of the other important points is the opportunity this creates is you've heard how PPOR is done at the community level, how it can be done at the state level, how we're working with our regional perinatal centers to do it at a regional level. The value of the PPOR is it can be done at the level of decision making. So it's who's around the table and you can use the data as long as it meets all the criteria, you can use the data at many different levels to engage groups who see value at that level.
So we have refined several of our programs to focus on the four populations of interest that I described. Women in the preconception and inter conception periods. African American women, teens and particularly African American teens.
So at the state level, we have begun to take action, and we've, and probably the first action is further analysis that, as I mentioned, every time we get one set of answers, then it triggers us to ask a whole new list of questions. But what we've done particularly with preconception and interconception health is amplified our prenatal and smoking among women of reproductive age. We applied for and were successful in becoming a state participating in AMCHP's action learning lab around prenatal smoking, and that's given actually a new opportunity to engage the Ohio section of ACOG which has been beneficial. Also doing more work with women who have a previous low birth weight and clearly trying to talk with people about the importance of that interconception period.
Again, addressing racial disparities, when we did our phase 2 analysis, late and inadequate prenatal care continues to pop out as a significant issue, when we looked at our teen population that was significant. So our outreach efforts clearly need to be amplified and focused.
So that's kind of a list, just a teaser, on all of the things that this method of analyzing data that we all have readily available to us did in terms of triggering new interactions with groups that we had not previously had such strong relationships. Thank you.