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Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality

Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality. Veronica L. Gunn, MD, MPH Chief Medical Officer, TN Dept of Health Michael D. Warren, MD Medical Director, Governor’s Office of Children’s Care Coordination.

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Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality

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  1. Novel Approach to Facilitating State-Local Collaboration to Reduce Infant Mortality Veronica L. Gunn, MD, MPH Chief Medical Officer, TN Dept of Health Michael D. Warren, MD Medical Director, Governor’s Office of Children’s Care Coordination

  2. We have no financial conflicts to disclose.We will not be discussing off-label use of pharmaceuticals in this workshop.

  3. Tennessee in National Rankings • 45th for Births to Teens • 43rd for Low Birth Weight Babies • 43rd for Preterm Births • 45th for Infant Mortality Annie E. Casey, Kids Count, 2008 (based on 2005 data)

  4. Infant Mortality Initiative--Background • March 2006 Comptroller’s Report • Racial • Geographic • Multifactorial risk factors for poor birth outcomes Former DOH Commissioner, Dr. Kenneth Robinson

  5. Infant Mortality Initiative--Background • GOCCC requested to lead collaborative effort • State legislature appropriations • Infant Mortality Initiative ($1.44M recurring) Monies draw 50% Medicaid match; efforts must be geared toward Medicaid-eligible population • Women’s Health Initiative ($5M, $3M recurring) Monies indicated to increase access to and utilization of prenatal and obstetric care in underserved areas of the state

  6. Guiding Principles • Use data to inform strategy development • Use Evidence-Based Practices when available • Evaluate all efforts • Develop partnerships to promote cooperation and collaboration • Empower the community to drive initiatives and instigate change

  7. Step 1: Identify Where the Problem is Located

  8. Infant Mortality Trends: TN and US, 1997-2006 BHIAT 2010 goal

  9. Tennessee White Population 6.6 Tennessee Black Population 16.8

  10. Infant Mortality Rates, 2002-2004

  11. Rates vs. Absolute Numbers:

  12. Priority Areas Shelby County Davidson County Hamilton County 10% 28% 5% Percent of Infant Deaths in Tennessee by Area, 2002-2004

  13. Step 2:Identify the Cause of the Problem

  14. AGE AT DEATH Post-neonatal Fetal Neonatal Maternal Health/ Prematurity 500-1499 grams WEIGHT AT BIRTH Maternal Care Newborn Care Infant Health 1500+ grams Perinatal Periods of Risk (PPOR) Adapted from City MatCH, CDC

  15. Preconceptual Health, Health Behaviors Maternal Health/ Prematurity Prenatal Care, High-risk Referral OB Care Maternal Care Perinatal Management Neonatal Care Pediatric Surgery Newborn Care Infant Health Sleep Position Breast Feeding Injury Prevention Intervention Points CityMatCH. “Perinatal Periods of Risk Approach in U.S. Cities.” January, 2007. http://www.citymatch.org/PPOR/

  16. Causes of Infant Mortality • Disorders Related to Preterm Birth and Low Birth Weight • Congenital Abnormalities • Sudden Infant Death Syndrome (SIDS)

  17. Determinants of Infant Mortality in Tennessee From: TN DOH, 2003

  18. Pregnant Smokers by Region

  19. Memphis Community Survey • Early childhood development polls—First Years Institute, University of Memphis • Memphis/Shelby County 2003-2006 • Reflective of early childhood public awareness campaign • Public awareness of issues related to infant mortality was quite high

  20. What would you say is the single most important problem facing your local community, that is the one that you, yourself are most concerned about?

  21. “Infant mortality is not a health problem. Infant mortality is a social problem with health consequences.”Marsden Wagner, Statement to the National Commission to Prevent Infant Mortality

  22. Factors Influencing Birth Outcomes Social & Economic Conditions Effectiveness of Services Knowledge Information Maternal and Infant Heath Utilization of Services Personal Choices Access to Services Families & Communities Societal Values

  23. Step 3:Action Build Capacity

  24. Build Capacity Metro Infant Mortality Coordinator Metro Infant Mortality Coordinator Metro Infant Mortality Coordinator

  25. Build Capacity GOCCC Metro Infant Mortality Coordinator Metro Core Leadership Group • Hospitals • Academic Institutions • Community Agencies • Faith Community • Local Businesses • Non-Profit Organizations

  26. Step 3:Action Build Capacity Implement Evidence Based Solutions

  27. Implement Evidence-Based Programs • Grants to enhance infrastructure and accessibility through personnel and equipment • Centering Pregnancy • Community Voice • Smoking Cessation intervention for pregnant women in Northeast Tennessee • Fetal Infant Mortality Review (FIMR) • TN Initiative for Perinatal Quality Care

  28. Exercise 1: Using Data to Identify Priorities

  29. Exercise 2: Establishing State-Local Collaborations

  30. Exercise 3: Promoting Sustainability

  31. $10 per person annually= $16 billion saved Tennessee could save $351 million (ROI of 6 to 1) Prevention is the Key Trust for America’s Health, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, July 17, 2008.

  32. Tying it Together… • Cross-pollination • Enhances service delivery • Promotes sustainability • Community Voice referrals to and from Centering Pregnancy • TIPS connections to 5A through HUGS and TN Quitline (1-800-QUIT-NOW) • MCO utilization of Centering Pregnancy as a disease management model

  33. Neonatal Hospital Costs by Gestational Age at Birth for Surviving Infants $14,000 32.6 weeks 34.8 weeks $4,700 Savings per Preterm pregnancy $9,300 Gilbert et al, 2003

  34. Pregnancy Savings with Centering Pregnancy in TN Neonatal Hospital Costs: Number of Preterm Pregnancies in TN (2004) Savings per Preterm Pregnancy Total Potential Savings $92,516,400 X $9,300 9,848 + + + Postneonatal hospital costs Postneonatal outpatient costs Infant and child excess medical costs attributed to preterm birth

  35. In 2005, hospital costs associated with pregnancy were $40 billion, second only to the $41 billion of charges incurred for heart disease • Cost of prematurity represents about 33% of a state’s total medicaid budget Average Cost of Hospital Care March of Dimes, 2005

  36. Costs of Preterm Birth Labor & Market Productivity 22% Special Education 4% 67% Medical Costs $26 7% Maternal Delivery (billions of $) Behrman RE et al., Preterm birth: causes, consequences, and prevention. Institute of Medicine. Nat’l Acad. Sci. (2006).

  37. In the U.S. the total annual health care charges for all infants totals $33.8 billion $15.5 billion of this (nearly half) is for premature births The average premature baby has a health care cost in the first year of life totaling $41,610 A healthy baby has an average cost of $2,766 The Economic Impact

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