Ruth Ann Shepherd, MD, FAAP Director, Division of Maternal and Child Health Kentucky Department for...

Ruth Ann Shepherd, MD, FAAPDirector, Division of Maternal and Child Health

Kentucky Department for Public HealthConnie Gayle White, MD, MS, FACOG

Women’s Health ConsultantFounding Member, Every Woman Southeast

KY Partnerships on Prematurity Kentucky Folic Acid Partnership

Since 1998; partnership with March of Dimes Over 100 members, 80 agencies across the state Prematurity Toolkit, HBWW project name Prematurity activities since 2005 (278,000 individual, 1.7M

media) Prematurity Summits- MOD and KPA – spring and fall

2004: “Prematurity, the Scope of the Problem” Frank Boehm 2005: “The Prematurity Problem: The Kentucky Data” 2006: “The Infant Born at 36 weeks is still Preterm”

Kentucky Perinatal Association HPEP – Health Professional Education on Prematurity

HPEP I - Pathways to Prematurity - 2005 HPEP II – Late Preterm Infants – 2007 HPEP III – Progesterone – 2009

National Perinatal Association Awards to KPA Innovation Award 2006 Best Chapter 2009

Pilot Projects: PRAMS, FIMR, GIFTS

A Collaborative Partnership• The Prematurity Prevention Partnership

March of DimesJohnson & Johnson Pediatric InstituteKentucky Department for Public Health

• Kentucky March of Dimes Chapter• Professional organizations (ACOG, AAP, AWHONN)• Kentucky perinatal leaders

Media Launch in Louisville, KYMarch 2007

Dr. David Smith, Dr. Jennifer Howse, Governor Ernie Fletcher, Dr. Steven Shelov, Mr. Shawn Crabtree

Overview• HBWW® is a three year (2007-2009) pilot program

that aims to reduce “preventable” preterm births at three Intervention Sites in KentuckyGoal: 15% reduction in the rate of singleton

preterm births at the intervention sitesMixed ecological “real world” designFocus on late preterm birth (34-36 weeks)Collaboration between hospitals, obstetricians,

and public health professionals and the local community

Provides education for pregnant women, the community and perinatal providers

HBWW Advisory Council• Biannual Site Council Meetings with leaders representing:

Participating agencies in KY (DPH: Commissioner, Director MCH, HANDS Coordinator, State Epidemiologist, etc.)

Perinatal professional organizations in KY (ACOG, AWHONN, KPA)

State March of Dimes Intervention sites (both hospital and health dept each site) Executive Program Board (national partners and project PI) Clinical experts in ob/gyn, maternal fetal medicine, neonatology,

pediatrics, family medicine, oral health, smoking cessation Communications/media experts

• Working Groups Intervention, Evaluation, Communication, ad hoc

Healthy Babies are Worth the Wait Interventions “Bundled” Evidence-Based Interventions Linked elements of clinical care, patient support, and public education:

– PartnershipsAdvisory Council, Local Implementation Teams,Local meetings with office managers, etc.

– Professional Education & Action• Grand Rounds & Training• Standard clinical guidelines (folic acid, smoking

cessation, progesterone, screenings)• Patient safety protocols

– Patient Education and Action• Augmenting existing services for case

management, screening & referral• Health Literacy in the context of prenatal care

– Public/ Community Education and Action• Community Toolkit• Media toolkit• Web site

HBWW® Health Messages• See the doctor BEFORE & DURING pregnancy

• Don’t smoke or use alcohol while pregnant

• Take folic acid every day

• Brush, floss and visit the dentist

• Avoid scheduled delivery before 39 weeks

• Babies’ brains grow a lot between 35 and 40 weeks

HBWW® MaterialsOral Health Products

•Stamped with website URL

Message Pens

Magnetic Photo Frames

Message Totes•Incentives for follow-up consumer survey

HBWW® MaterialsBrain Card

•Not to be distributed directly to patients

•Utilized by providers to facilitate communication with patients

Community Outreach Education & Action Community Toolkit (KFAP)

Message: Preventing Prematurity saves babies lives and improves the future for families and for communities.

Fact Sheets, Handouts, Powerpoint, Instructions for Activities, Reporting form, evaluation

English and Spanish Media in Intervention Communities

Media Toolkit for traditional media Hospital and health department media teams

Digital media interventions www.prematurityprevention.org Facebook, Twitter

State and National Outreach- 26 state professional meetings- 12 national meeting presentations- nearly 100 media coverages

Web-based Resources: www.PrematurityPrevention.org

Provider “Grade Card” sampleSummary of Inductions and Scheduled C/S of Infants prior to 39 wks GA

PHYSICIANS TotalMedical

Indication

Medical Indication

Rate

Infants Admitted to NICU Who Were

Induced or Sectioned Without Medical Indication

Doc A 5 5 100% 0

Doc B 3 1 33% 0

Doc C 2 2 100% 0

Doc D 3 2 66% 0

Late Preterm BirthMonthly Comparisons

(percent of deliveries)

Jan Feb Mar Apr May

Jun Jul Aug Sep Oct Nov Dec YR Avg

2006

11 10 10 11 18 13 11 20 13 8 16 10 13

2007

14 21 13 12 10 11 12 11 7 9 8 13 12

2008

12 12 12 11 14 13 10 8 10 10 10 11 11

2009

6 7 7 13 19 7 6 9 8 11 6 11 9

Partnership ExampleInitial Grand Rounds included information on

periodontal disease and prematurityDiscussions with providers no local

dentists would see pregnant womenFrom HBWW Advisory Committee, national

oral health expert (Dr. John Novak) agreed to provide educational session

HBWW team and Local Dental Society partnered to sponsor combined educational session for medical and dental providers

●After the educational session, some local

dentists more willing to accept pregnant

patients

●HBWW team meeting with OB office managers

got feedback that only some dentists were

participating

●HBWW team followed up with each local dentist,

providing additional materials and answering

remaining questions about dental care for

pregnant women

●Additional dentists in the area agreed to provide

dental care for pregnant women

●Office mangers now reporting they are able to

get women in for dental care most of the time.