Collaborative Improvement & Innovation Network (CoIN) to Reduce Infant Mortality

1. Collaborative Improvement & Innovation Network (CoIN) to Reduce Infant Mortality Healthy Start Grantee Meeting September 18, 2012 Reem M. Ghandour, DrPH, MPA COIN Coordinator / Public Health Analyst Office of Epidemiology and Research Maternal and Child Health Bureau Health Resources and Services Administration Department of Health and Human Services

2. What is a CoIN? A CoIN, or Collaborative Innovation Network, has been described as a cyber-team of self-motivated people with a collective vision, enabled by the Web to collaborate in achieving a common goal by sharing ideas, information, and work.1 • Key Elements of a COIN are: • Being a “cyberteam” (i.e. most COIN work will be distance-based); • Innovation comes through rapid and on-going communication across all levels. • Describes how individuals will work (and learn) collaboratively to develop, implement, and evaluate strategies to reduce infant mortality. • Adapted to reflect focus on both innovation and improvement Collaborative Improvement & Innovation Network to Reduce Infant Mortality (COIN). 1 Gloor PA. Swarm Creativity: Competitive Advantage through Collaborative Innovation Networks. New York: Oxford University Press, 2006.

3. Born out of January 2012 Infant Mortality Summit in New Orleans, LA for Regions IV and VI as well as previous work by ASTHO and March of Dimes. Designed to meet stated needs related to: Common evidence-based strategies to reduce infant mortality; Shared, collaborative learning and action across states. 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. Developed in (ongoing) partnership with ASTHO, AMCHP, March of Dimes, CityMatCH, CMS, and CDC and (emerging) partnership with AAP, AHA, AWHONN, NQF-NPP, Healthy Start, Home Visiting… CoIN: History

4. 5 Strategy Teams focused on common state-identified priorities: Reducing elective deliveries <39 weeks (ED); Expanding interconception care in Medicaid (IC); Reducing SIDS/SUID and promoting safe sleep (SS); Increasing smoking cessation among pregnant women (SC); Enhancing perinatal regionalization (RS). Teams 2-3 Leads (Topical Experts); Data and/or MethodsExperts (as needed); 2 Staff from MCHB and Partner Organizations; Self-selected Members from each of the 13 states in Regions IV and VI. Teams average 25-30 members. State delegations range from 7-13 members. CoIN: Structure

5. Reduce Elective Deliveries LEAD: David Lakey (Region VI-TX, SHO; ASTHO) LEAD: Ruth Ann Shepherd (Region IV-KY, MCH) DATA: Bill Sappenfield (Region IV-FL; USF) PARTNER STAFF: Ellen Schleicher Pliska (ASTHO) MCHB STAFF: Kate Marcell (DSCH) Increase Access to Interconception Care LEAD: Al Brann (Emory University, GA) LEAD: Rebekah Gee (Region VI-LA, MCH) LEAD: Stephen Cha (CMS) METHODS: Kay Johnson PARTNER STAFF: Brent Ewig (AMCHP) MCHB STAFF: Deb Wagler (DSCH) Promote Safe Sleep -- SIDS/SUID LEAD: Carrie K. Shapiro-Mendoza (CDC, DRH) LEAD: Kim Wyche Etheridge (Regional MCH Director) DATA: Lyn Kieltyka (CDC Assignee) PARTNER STAFF: Carol Gilbert (City MatCH) MCHB STAFF: Erin Reiney (MCHB) Increase Smoking Cessation LEAD: Suzanna Dooley (Region VI-OK, MCH) LEAD: Cathy Taylor (College of Health Sciences & Nursing, Belmont University, TN) DATA: Laurin Kasehagen Robinson (CityMatCH, CDC Assignee) PARTNER STAFF: Norm Hess (MOD) MCHB STAFF: Vanessa Lee (DSCH) Improve Regional Perinatal Systems LEAD: Wanda Barfield (CDC, DRH) LEAD: Paul Halverson (Region VI-AR, SHO) LEAD: Kate Menard (NC; Society for Maternal-Fetal Medicine) PARTNER STAFF: Lauren Raskin Ramos (AMCHP) MCHB STAFF: Kathy Watters (DSCH) CoIN: Structure – Team Leadership

6. CoIN: Structure (cont.) • Lifespan: 12-18 months (beginning July 2012). • Support provided by contract through MCHB to do Quality Improvement and Collaborative Learning. • Technical assistance around QI (Aim development, strategy identification, and selection of metrics). • Monitoring/tracking for rapid-cycle improvement through shared workspace and data dashboard. • Foci, activities, and outcomes are Team driven.

7. CoIN: Work to Date • Team Driven! • Focused on: • Preparation for face-to-face launch July 23-24; • Defining the scope and nature of the problem; • Developing aim statement; • Identifying possible action strategies; • Identifying related metrics to track progress; • Development of driver diagram; • Maintaining “tempo”; • Identifying additional Team members.

8. CoIN: Work to Date • The Institute for Healthcare Improvement (IHI) Model for Improvement requires Collaborative teams to ask three questions: • AIM: What are we trying to accomplish? • Participants determine which specific result they are trying to change through their work. • MEASURE: How will we know that a change is an improvement? • Team members identify appropriate measures to track their success. • CHANGE: What changes can we make that will result in improvement? • Teams identify key changes that they will actually test (small, specific).

9. CoIN: Work to Date – DRAFT Aims • Increase Safe SleepThe Safe Sleep COIN intends to increase infant safe sleep practices by 5% by December 2013 for all racial and ethnic groups in Region IV and VI states because unsafe sleep practices remain prevalent and are known to contribute to SIDS and other sleep-related sudden unexpected infant deaths. • Reduce Elective Deliveries < 39 WeeksThe Elective Delivery Improvement Team intends to reduce non-medically indicated deliveries < 39 weeks by 33% by August of 2013, in Region IV and VI states.

10. CoIN: Work to Date – DRAFT Aims • Perinatal RegionalizationWithin 18 months increase to 90 percent or by 20 percent above baseline, mothers delivering at appropriate facilities to include infants less than 32 weeks gestation and/or less than 1500 grams. • Increase Smoking Cessation among Pregnant WomenTo decrease the tobacco smoking rate by 3% among pregnant women in the States of Regions IV and VI by December 31, 2013.

11. CoIN: Work to Date – DRAFT Aims • Expand Interconception CareThe Interconception Care and Medicaid Strategy Team will modify Medicaid policies and procedures in 5-8 southern states by December 2013 in order to improve access to and financing of postpartum visits and interconception care and case management for women who have experienced a Medicaid financed birth that resulted in an adverse pregnancy outcome.

12. CoIN: Challenges • Logistics; • Regional, inter- and intra-State differences; • Strategy-specific challenges; • Implementation of collaborative practices; • Application of QI principles to public health challenges; • Maintaining momentum.

13. CoIN: Strengths • People • Commitment • Partners • Momentum

14. CoIN: Strengths -- Momentum Toward A National Strategy on Infant Mortality And where infant mortality has taken the highest toll in the US, we’re also partnering with state officials to create strategies and interventions to begin bringing these rates down.  Our plan is to find out what works and scale up the best interventions to the national level. Secretary Kathleen Sebelius June 14, 2012

15. CoIN: Next Steps (6 months) • COIN Teams to further develop & refine by October 1, 2012: • Aims • Strategies • Metrics • Driver diagrams • Link Aims and Strategies to existing local, state, and national efforts, including Healthy Start, Home Visiting, etc.

16. CoIN: Next Steps (6 months) • COIN Teams/Team Members: • Start implementing strategies at State level; • Start tracking common measures on both process and outcomes (short and midterm). • Monthly Team Lead calls + Team Staff calls. • Coordination with partners and other national initiatives. • Planning for 2nd face-to-face meeting (i.e., Learning Session) and expansion to Region V.

17. CoIN: Summary • Launched in response to stated needs among the 13 States in Regions IV and VI. • Designed to help states use the science of quality improvement and collaborative learning to improve birth outcomes over the next 12-18 months. • Participant driven. • Part of a portfolio of efforts to improve birth outcomes and works in partnership with these initiatives.

18. Contact Information Reem M. Ghandour, DrPH, MPA Public Health Analyst Maternal and Child Health Bureau 301-443-3786 rghandour@hrsa.gov

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