Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Susan E. Wilson, BGS Healthy Babies Program Director Ty Kane, MPH Community Health Analyst

Kansas Blue Ribbon Panel on Infant Mortality

August 28, 2009

Susan E. Wilson, BGS Healthy Babies Program Director

Ty Kane, MPHCommunity Health Analyst & IMR Coordinator

Improve birth outcomes among at-risk moms by reducing the incidence of premature and low birth weight births and infant deaths.

Group Education

In-office Visits

Home Visits

Nutrition/Healthy Weight Labor & Delivery Basic Baby Care Breastfeeding Infant Growth and Development Parenting Skills Relationships Birth Spacing Sexually Transmitted Diseases Self-Esteem and Goal-Setting Education, Employment and Budgeting

Smoking

Depression

Domestic Violence

Drug and Alcohol Use

Lead Poisoning

Infant Development

716 Incoming Referrals

8,500 Group, Homeand Office Encounters

1,021 Moms & Babies

Decrease the Infant Mortality Rate

Decrease the Premature Birth Rate

Reduce the Low Birth Weight (LBW) Rate Increase Prenatal Care Entry

Increase Breastfeeding Rates

(info from www.modimes.org)

Annual budget ($1.78 million)

Additional one-time monies SFY2010 ($569K)

88% grant funded

31% of total funding is federal Healthy Start

Northeast Wichita Healthy Start Initiative – referred to as NEWHSI

Funded since 1997

Targeted zip codes (67208, 67214, 67219)

Poor African American birth outcomes

Applications in 2007 and 2008 to extend targeted zips to 67203, 67210, 67213 and 67218 were approved by HRSA but unfunded due to budget constraints

All races (all zips) 16.72 deaths/1,000 African American (all zips) 26.50

deaths/1,000 Up from 16.49 for the three years ending 2000

All races (67214) 21.07 deaths/1,000

African American (67214) 26.12 deaths/1,000

Up from 21.67 for the three years ending 2000

Data provided by KDHE

0.00 infant deaths reported (2002-2007)

For clients residing in one of the three NEWHSI zip codes and enrolled in the Healthy Babies program

Two infant deaths reported (grant year 2008)

For all clients enrolled in the Healthy Babies program, all zip codes

Both unpreventable due to congenital anomalies


21.67

26.11

28.19

31.84

28.51 28.36 27.99

26.12

16.4918.07 17.73 17.71 17.75

22.20

24.46

26.50

15.75

18.56

20.6421.52

20.28

22.87 23.44

21.07

9.54

11.3712.95 12.91

12.00

15.4316.37 16.72

6.94 7.10 7.07 7.05 7.00 7.11 7.27 7.53

7.09 7.02 6.96 6.88 6.75 6.63 6.52 6.432.00

1.000.00 0.00 0.00 0.00 0.00 0.00

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

NEWHSI (67214-Blk) 21.67 26.11 28.19 31.84 28.51 28.36 27.99 26.12

NEWSHI (Blk) 16.49 18.07 17.73 17.71 17.75 22.20 24.46 26.50

NEWHSI (67214) 15.75 18.56 20.64 21.52 20.28 22.87 23.44 21.07

NEWSHI 9.54 11.37 12.95 12.91 12.00 15.43 16.37 16.72

Kansas 6.94 7.10 7.07 7.05 7.00 7.11 7.27 7.53

US 7.09 7.02 6.96 6.88 6.75 6.63 6.52 6.43

NEWHSI Clients 2.00 1.00 0.00 0.00 0.00 0.00 0.00 0.00

1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007

Infa

nt

Mo

rtality

Rate

(p

er

1,0

00)

NEWHSI Infant Mortality Rate Comparisons - Based on 3-year averagesData provided by KDHE Office of Health and Environmental Statistics

Data provided by KDHE Bureau of Health Informatics

Social marketing campaign targeting preconception care

Use Community Navigators to provide peer education among at-risk populations and increase referrals

Provide reproductive health education to middle and high school students in the Wichita Public Schools

Implement new software to increase ability to analyze and share birth outcome data with KDHE and local evaluator

Extend the Infant Mortality Review (IMR) Project to help determine the social factors associated with infant deaths in Sedgwick County

Fall 2004 – Began dialogue with KDHE regarding data needs as related to the NEWHSI grant

Fall 2004 thru Fall 2007 Purchased zip-code specific data from KDHE Nurtured partnership with KDHE Bureau of Health Informatics and the

Kansas City Healthy Start (KCHS) Project via phone and in-person meetings to discuss grant objectives, program outcomes and target area stats

Fall 2007 – Partner with KCHS to fund KDHE research agreement to gain “greater understanding of the social and health issues related to pregnancy outcomes and infant mortality…”

Fall 2008 thru Spring 2009 – Chart Abstractions

June 2009 - Convene Case Review Team (CRT)

February 2010 – Begin abstraction of 2010 charts

Sedgwick County Health Department Kansas City Healthy Start Kansas Department of Health and Environment

Bureau of Health Informatics Bureau of Local and Rural Health

Central Plains Regional Health Care Foundation Medical Society of Sedgwick County KUMC– Wichita, Office of Research SIDS Network of Kansas

Created as part of an on-going KDHE QA/QI project

Bureau of PHI authority allows abstraction of maternal and infant death records:

To verify hospital compliance with completing birth and infant death certificates

To collect data specific to infant deaths and stillbirths (No patient contact; Work by KDHE staff)

To allow comparison of birth outcome data between individuals served/not served by Healthy Babies (All work done in non-identifying manner)

KS Statute puts restrictions on a maternal interview

To facilitate the bereavement process and provide appropriate referrals.

To learn about the mother’s experiences before and during pregnancy.

To learn about events during the infant’s life and around the time of death.

To identify community assets and deficits that affected the mother’s life during the pregnancy, birth and death of her infant.

To accurately summarize and convey the mother’s story of her encounters with local service systems and her loss to the community thru the FIMR case review.

To assess the family’s needs and provide culturally appropriate health and human service referrals as needed.

95 Charts abstracted at Via Christi and Wesley 63 infant deaths 32 stillbirths

Non-Hispanic (82.1%) Black (22.1%) White (53.7%) Other (6.3%)

Identified Payer Source (51.6%) MCD (49.5%) Private Insurance (2.1%) Self-pay (36.8%)


Singleton Births (88.4%)

Prematurity (71.6%) Very Preterm/<32 weeks (50.5%) Moderate Preterm/32-33 weeks (11.6%)

Mother’s age <30 (72.7%) <20 yrs. (24.2%) 20-24 yrs. (18.2%) 25-29 yrs. (30.3%)

Pre-pregnancy abnormal BMI (84.4%) Underweight (14.7%) Overweight (15.2%) Obese (27.3%)


Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”

* ASSURE COMMUNITY READINESS *

Develop Programmatic Features

Build Community Support and Collaboration

Define the Community Determine sponsoring agency

Determine relationship to other review processes

Build support from community services

Identify costs and funding sources

Identify FIMR team participants

Identify and address legal and institutional issues

Hold town hall meeting

Set up procedures and policies Develop mission statement

Reporting to community

Administrative functions

* INITIATE FIMR CASE REVIEWS *




NEWHSI Zip Codes versus other Sedgwick County zip codes

Define the Community




Set up procedures and policies







KS Child Death Review Board (CDRB)• Has the statutory obligation to review the death of every child that is a KS resident or dies in KS.• Examines trends and patterns that identify risk factors in the deaths of children, from birth through 17 years of age. (www.ksag.org)

Sedgwick County Infant Mortality Review• Examine deaths of children between 20 weeks gestation and one year of age.• The overall goal of a FIMR is to enhance the health and well being of women, infants and families by improving the community resources and service delivery systems available to them.












Sedgwick County IMR financial supporters:

Central Plains Regional Health Care Foundation Healthy Babies Program• NEWHSI grant• CDC Safe Motherhood grant












Authority to perform abstraction activities and to review abstracted case summaries has been reviewed by KDHE and SCHD legal staff












Policies and procedures have been drafted and are in progress for:

Project overview (Authority, Mission, Vision, Goals)

Roles and Responsibilities

Case Review Team (CRT)

Community Action Team (CAT)

Confidentiality

Case Identification, etc.












NFIMR recommends:

• Media sub-committee• Annual FIMR report












Currently managed by SCHD staff:

Susan Wilson, Healthy Babies Program Manager

Ty Kane, Community Health Analyst











From “The Evaluation of FIMR Programs Nationwide”-Women’s and Children’s Policy Center at Johns Hopkins University

Where are FIMR’s housed?

• 65% LHD• 12% Community organization• 8% Healthy Start• 7% Hospital• 8% Other


Determine the sponsoring agency




Develop mission statement




Current partners include:• Center for Health and Wellness• Hunter Health Clinic• SIDS Network of Kansas• African American Coalition• Kansas Children’s Service League• March of Dimes• Catholic Charities• Wichita Radiological Group• Maternal-Fetal Associates• COMCARE of SG County• SG County Human Services• Wichita Police Department• USD 259, Wichita Public Schools• Via Christi • Wesley Medical Center• Associates in Women’s Health Care• Wichita Children’s Home


Determine sponsoring agency








Recruit key community leaders, health care providers, public health providers, human service providers, consumer and advocacy groups

CRT recruitment and initial informational meeting, mid-2009

CRT Training set for 9/30/09

CAT recruitment, late 2009










Planning team will consider some type of kick-off or community engagement event










Yet to be finalized.

.. will be guided by diversity, commitment and consumer participation.








Enter into new agreement with KDHE to begin 2010 case abstractions.

Hire abstracter and hold “real-time” case reviews.

Further develop Community Action Team (CAT).

Use 2005 case review data as baseline to compare to 2010 data.

Sedgwick County NEWHSI residents NEWHSI residents served by Healthy Babies Program

Susan E. Wilson, BGS Program DirectorHealthy BabiesSedgwick County Health Department434 N. Oliver, Suite 110Wichita, KS [email protected]

Ty Kane, MPHCommunity Health Analyst &IMR CoordinatorSedgwick County Health Department1530 S. Oliver, Suite 270Wichita, KS [email protected]

Documents

Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Susan E. Wilson, BGS Healthy Babies Program Director Ty Kane, MPH Community Health Analyst