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State Infant Mortality (SIM) Collaborative

State Infant Mortality (SIM) Collaborative. Loretta J. Fuddy, MPH, MSW Gigliola Baruffi, MD, MPH Mark Eshima, MA AMCHP March 2006. Lessons Learned # 1 Partnership is Vital.

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State Infant Mortality (SIM) Collaborative

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  1. State Infant Mortality (SIM) Collaborative Loretta J. Fuddy, MPH, MSW Gigliola Baruffi, MD, MPH Mark Eshima, MA AMCHP March 2006

  2. Lessons Learned # 1 Partnership is Vital • To affectively analyze and address the issue of infant mortality requires the cooperation and partnership of private and public systems of care. • Advising and directing SIM collaborative activities. • Accessing quantitative data sources. • Asking the right questions. • Accessing qualitative data sources. • Advocating for larger system involvement.

  3. Representation in the Hawaiÿi SIM Collaborative • Hawai`i State Department of Health • University of Hawaiÿi School of Medicine • March of Dimes Hawaiÿi Chapter • University of Hawaiÿi School of Nursing • Kapiÿolani Medical Center for Women and Children (KMCWC) • Healthy Mothers, Healthy Babies Coalition of Hawaiÿi (HMHB) • Medical Community: - Pediatrics - Obstetrics - Perinatalogy - Neonatalogy

  4. Goal: Reduce Hawaii’s Prematurity, Low Birth Weight and Infant Mortality Rates • Objective 1. By December 31,2005, identify the major protective and risk factors associated with poor birth outcomes. • Objective 2. By October 31, 2006, disseminate a Strategic Plan to address maternal characteristics, health behaviors, and health care delivery system characteristics associated with these adverse birth outcomes.

  5. Objective 1. Identify major protective and risk factors associated with poor birth outcomes. Identify any changes in: • Population Characteristics. • Hawai`i Economic Environment • Patterns of Immigration health status. • Lifestyle and Health Behaviors. • Community Environment.

  6. State of Hawaiÿi Resident Infant Mortality Rate: 1902-2003

  7. Lessons Learned - # 2 Data Analysis generates more questions than answers. • Infant Mortality is Multifaceted. • Vital data trend analysis, and analysis surveillance information may not be sufficient to decipher key determinants. • Qualitative data analysis is necessary to examine delivery system and community wide issues.

  8. What data sources has Hawai’i analyzed? • Vital Statistics (birth, death, fetal death, infant death, ITOP) • Hawaiÿi Pregnancy Risk Assessment Monitoring System (PRAMS) • Child Death Review • Birth Defects Monitoring • Hospital Discharge Data • Medical Chart Review • Mälama A Hoÿopili Pono (Caring for Mothers and Children in the Right Way) Healthy Start

  9. Data Analysis • Trend data - Demographic Characteristics - Complications of Labor and Delivery - Medical Risk Factors - Obstetric Procedures - Acute Problems of Newborn - Congenital Anomalies of Child - Concurrent Illnesses or Conditions • Perinatal Periods of Risk Analysis • Fetal Infant Mortality Review Model • Unique Population Comparisons

  10. Development of Qualitative Data – Partnership Driven • Chart Review • Physician and hospital cooperation • NICU information • March of Dimes Involvement • Trends in Provision of Care • UH School of Nursing • UH School of Medicine • MCH Lend Project • Professional Organization

  11. Lessons Learned - # 3 Does size matter? • Small states with small number of births presents unique challenges to investigate the causes of infant mortality. • Year to Year variability • Geographic variability • Ethnic variability • Maternal characteristics over time.

  12. State of Hawaiÿi Resident Infant Mortality Rate: 1980-2004

  13. Resident Infant Mortality Rate: Confidence Intervals

  14. Map: State of Hawai`i

  15. Map: Island of Hawaiÿi

  16. Hawaiÿi’s Ethnic Diversity Source: Hawaii. Department of Health. Office of Health Status Monitoring

  17. Lesson # 4 Not the Usual Suspects • Maternal Characteristics • Ethnicity/Race • Nutrition • Health Insurance Coverage • Marital Status • Tobacco/Substance Abuse • Entry into Care • Variation of Delivery System • Economic Environment • Immigration Patterns

  18. Where Do We Go From Here? • Qualitative health care system data • Creative data comparison • Expanded partnership to develop a new list of questions and possible data sources. • What policy issues does Hawai`i need to develop?

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