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Creating Community Involvement to Conduct a Perinatal Periods of Risk Assessment Rita Beam, MS, RN Nurse Manager of Per

Creating Community Involvement to Conduct a Perinatal Periods of Risk Assessment Rita Beam, MS, RN Nurse Manager of Perinatal Services. The Problem.

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Creating Community Involvement to Conduct a Perinatal Periods of Risk Assessment Rita Beam, MS, RN Nurse Manager of Per

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  1. Creating Community Involvement to Conduct a Perinatal Periods of Risk Assessment Rita Beam, MS, RNNurse Manager of Perinatal Services

  2. The Problem • The mortality rate among African American/ Black infants residing in Aurora, Colorado is significantly higher compared to the infant mortality rate for of other racial and ethnic groups within Aurora and throughout Colorado

  3. First Steps • Analyzed Black - White infant mortality data • Presented data indicating the health disparity to the Healthy Start (HS) Consortium • Determined to be the focus of the HS Local Action Plan

  4. Target Population and Geographic Area was Defined • Identified target population in the Healthy Start service area in Aurora, CO • Reviewed Pregnancy Risk Assessment Monitoring System (PRAMS) oversampling of the Aurora African American population • Reviewed Arapahoe County infant mortality rate (IMR)

  5. Percent African American Population in Arapahoe County by Block-Group Based on U.S. Census 2000 Summary File 3 Block-Group Data GIS 6/7/2006

  6. Action Steps • Consortium referred the problem to a small task force • Task force members • Healthy Start Program Coordinator • Local public health perinatal nurse manager • March of Dimes • State public health prenatal consultant • Collected qualitative data from key community informants

  7. Action Steps • Analyzed key informant interviews and presented to Healthy Start consortium • Consortium provided recommendations for follow up • Created proposal to form a community collaborative to address this health disparity

  8. Community Collaboratives • Researched the efficacy of a community collaborative to address complex health issues • Explored resources and funding • Formed key partnerships to support the collaborative • Identified key community leaders

  9. Healthier Beginnings for African-American/Black Communities: An Aurora Healthy Baby Initiative • Established to address infant morbidity and mortality disparities among African American/ Black families • Community partnerships • City of Aurora • Metro Center Provider Network’s Healthy Start Project • March of Dimes • Tri-County Health Department (TCHD)

  10. 2007 – 2009 Progress to Date • Meetings began June 2007 • Monthly • Engaged professional facilitator • Awarded March of Dimes grant • REACHUS • Applied and invited to participate in National Action Learning Collaborative

  11. 2007 – 2009 Progress to Date • Awarded MCH innovative health grant • PPOR process • Website • Program evaluation, Strategic Plan, Logic Model

  12. Excess Black Fetal-Infant Mortality Rate in Aurora, 1999-07

  13. PPOR Phase I Analysis - Conclusions • Fetal and infant mortality disparities continue to persist within the Black community in Aurora • Majority of excess mortality occurred in two PPOR categories • Maternal health/prematurity (60%) • Infant care (36%) • Findings suggest that efforts to reduce fetal-infant mortality in the Black community of Aurora should focus on reducing risk factors affecting maternal health, low birth weight and education to improve infant care

  14. Maternal health/ prematurity Preconception health Health behaviors Perinatal care Maternal care Prenatal care High risk referral Obstetric care Perinatal management Neonatal care Pediatric surgery Newborn care Infant health Sleep position Breast feeding Injury prevention

  15. Website www.aurorahealthybabies.org

  16. Next Steps • Funding for both outreach to community and to engage healthcare system • Continue to build community partnerships • Approach City of Aurora to indentify project as city initiative • Conduct phase II of PPOR

  17. Lessons Learned • Needed a champion from community • Needed to establish consistent leadership • Involvement of city leader was key • Funding, funding, funding

  18. Acknowledgements • Barb Stone, MPH, Health Planner, TCHD • Tiffany White, PhD, MPH, University of Colorado • Allison Hawkes, MD, MS, Planning, Evaluation and GIS Manager, TCHD • Richard L. Vogt, MD, Executive Director, TCHD

  19. Questions? Rita Beam, MS, RN Nurse Manager, Perinatal Services Tri-County Health Department rbeam@tchd.org 303-783-7148

  20. Age at Death Fetal Death Post- neonatal Neonatal Birthweight 500-1499 g Maternal Health/ Prematurity 1500+ g Newborn Care Infant Health Maternal Care Perinatal Periods of Risk (PPOR)Phase I-Fetal Infant Mortality “Map” Group labels suggest the primary preventive direction for the deaths in that group.

  21. Group-Specific Mortality Rates Number of feto-infant deaths Number of live births & fetal deaths X 1000 • Same denominator used for each group. • Group rates will add together to equal the overall • feto-infant mortality rate.

  22. Building the PPOR “Map” • Use linked infant birth-death and fetal death files • Include fetal deaths • Do NOT include: • Fetal deaths that occur <24 weeks gestation • Fetal deaths weighing < 500 grams • Live births weighing < 500 grams • Spontaneous and induced abortions

  23. Study Population • Live births and infant deaths 2003-2007* • birth weight >500 grams • Fetal deaths 2003-2007* • Gestational age ≥ 24 weeks • birth weight >500 grams • Reside within the city limits of Aurora, Colorado • Born to non-Hispanic Black women * Data Source: Health Statistics Section,Colorado Department of Public Health and Environment

  24. Reference Group • External • Residents of Colorado • Years 2003 to 2007 • Non-Hispanic white mothers • 20+ years of age • 13+ years of education

  25. Distribution and Rates of Feto-Infant MortalityAll Races, Aurora, CO, 2003-2007 Fetal Death Post- neonatal Neonatal Maternal Health/ Prematurity 3.2 (n=88) 500-1499 g Maternal Care 1.9 (n=52) Newborn Care 1.0 (n=28) Infant Health 1.4 (n=38) 1500+ g 27322 live births and fetal deaths Total feto-infant mortality rate: 7.5 = 206 fetal and infant deaths Data Source: 2003-2007 Linked Birth-Death and Fetal Death records, prepared by the Colorado Department of Health and Environment, Health Statistics Secton.

  26. Excess Feto-Infant Mortality RateAurora, CO vs. External Reference Group, 2003-2007 All Races (Aurora) External Reference (Colorado, non-Hispanic White) Excess 2.0 3.7 5.7 ─ = 1.4 0.8 N/A* 2.1 1.0 N/A* N/A* 1.4 N/A* ─ = 7.5 5.3 2.2 *Insufficient Numbers Data Source: 2003-2007 Linked Birth-Death and Fetal Death records, prepared by the Colorado Department of Health and Environment, Vital Statistics.

  27. Overall and Excess Feto-Infant Mortality Rates, Aurora, CO 2003-2007 *Colorado, non-Hispanic White, 20+ years of age, 13+ years of education

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