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Welcome. Perinatal Continuum of Care Tulsa County 2007. From Community Service Council of Greater Tulsa’s Community Profile 2007. Family Health Coalition. Established in 1987 to improve access to prenatal care 109 members from 60 agencies, businesses, government and consumers - PowerPoint PPT Presentation
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Perinatal Continuum of Care
Tulsa County 2007
From Community Service Council of Greater Tulsa’s Community Profile 2007
Family Health CoalitionFamily Health Coalition
Established in 1987 to improve access to prenatal care
109 members from 60 agencies, businesses, government and consumers
Local health system plan articulates with the Oklahoma State Department of Health 5 Year Plan for Maternal and Child Health (Title V)
Conducts on-going assessments and system evaluation
Conducts policy advocacy Conducts resource and grant development
Established in 1987 to improve access to prenatal care
109 members from 60 agencies, businesses, government and consumers
Local health system plan articulates with the Oklahoma State Department of Health 5 Year Plan for Maternal and Child Health (Title V)
Conducts on-going assessments and system evaluation
Conducts policy advocacy Conducts resource and grant development
Family Health Coalition
Community HealthNet
Steering Committee
Social Marketing
Access Committee
System Evaluation
Tulsa HispanicResource Association
Hea
lthy
Star
t Fu
ndin
g
(Fed
eral
Mon
ey
Offi
ce o
f Chi
ld
Abu
se P
reve
ntio
n Fu
ndin
g
(Fed
eral
Mon
ey
Outreach (Babyline & Free
Pregnancy Testing)
Case Management (Healthy Start, Children First &
Healthy Families)
Client Education (Prenatal, Sexuality &
Social Marketing)
Provider Training
Con
trib
utio
ns.
Cor
pora
te G
ivin
g
Phila
nthr
opy
Indi
an H
ealth
Se
rvic
e
(F
eder
al M
oney
Gra
duat
e M
edic
al
Educ
atio
nal F
undi
ng
(F
eder
al M
oney
WIC
Fun
ding
(Fed
eral
Mon
ey
Title
XFu
ndin
g
(F
eder
al M
oney
Title
V F
undi
ng
(F
eder
al M
oney
GQ
HC
/330
Fu
ndin
g
(Fed
eral
M
oney
Med
icai
d Fu
ndin
g
(
Ble
nd o
f Fed
eral
&
Sta
te M
onie
s
Prenatal Health Care Providers
Indian Health Care Resource Center
Tulsa Health Department
OU (OB/Gyn & Family Medicine)
Planned Parenthood
OSU (OB/Gyn & Family Medicine)
Morton Comprehensive Health Center
ServicesFamily PlanningPrenatal Care
Labor & DeliveryPre-conceptual Care
Inter-conceptual CarePsycho-social Screening
Risk Appropriate ReferralsTranslation
Behavioral Health Treatment
Reduction in Fetal & Infant Mortality
Reduction in Low Birth-Weight Babies
Reduction in Preterm Deliveries
Improved Access to Prenatal Care
Tulsa’s Perinatal Health Care System Works
Outcomes and Process Objectives
Outcomes and Process Objectives
Reduce fetal and infant mortality
Reduce low birth weight and very low birth weight infants
Reduce prematurity
Reduce fetal and infant mortality
Reduce low birth weight and very low birth weight infants
Reduce prematurity
Increase access and continuity in prenatal care
Reduce need for high risk obstetrical care
Reduce rate of no or late prenatal care
Increase access and continuity of family planning
Reduce unintended pregnancy
Reduce teen birth rate Increase capacity of CBO
to provide prenatal and intraconceptional care
Increase research and services in women’s health
Increase access and continuity in prenatal care
Reduce need for high risk obstetrical care
Reduce rate of no or late prenatal care
Increase access and continuity of family planning
Reduce unintended pregnancy
Reduce teen birth rate Increase capacity of CBO
to provide prenatal and intraconceptional care
Increase research and services in women’s health
Prepared by the Community Service Council of Greater Tulsa
Strategic Framework
Source: Substance Abuse and Mental Health Services Administration (SAMHSA.).
Organize community to profile needs, including community readiness
Mobilize community and build capacity to address
needs
Develop the prevention plan (activities,
programs & strategies
Implement prevention plan
Evaluate for results and sustainability
1: Assessment
2: Capacity
3: Planning4: Implementation
5: Evaluation
Sustainability & cultural competence
AssessmentAssessment
Review of Linked Birth and Death Certificate
Data 1991-2000 (Tulsa Health Department, 2004)
Analysis of Feto-Infant Mortality 1996-2000 (Tulsa
Health Department, 2004)
Assessment of Reproductive Indicators in Women of Minority Race and Ethnicity in
Eastern Oklahoma (Planned Parenthood of Arkansas and Eastern Oklahoma, 2005)
Barriers to Help-Seeking for Economically Disadvantages Parents and Children in Tulsa (Oklahoma State University, 2006)
Barriers to Early Prenatal Care: PRAMS 2000-2003 (Oklahoma State Department of Health, April 2007)
Review of Linked Birth and Death Certificate
Data 1991-2000 (Tulsa Health Department, 2004)
Analysis of Feto-Infant Mortality 1996-2000 (Tulsa
Health Department, 2004)
Assessment of Reproductive Indicators in Women of Minority Race and Ethnicity in
Eastern Oklahoma (Planned Parenthood of Arkansas and Eastern Oklahoma, 2005)
Barriers to Help-Seeking for Economically Disadvantages Parents and Children in Tulsa (Oklahoma State University, 2006)
Barriers to Early Prenatal Care: PRAMS 2000-2003 (Oklahoma State Department of Health, April 2007)
AssessmentAssessment
Babyline 1990-2004 Trend Report (Community Service Council,
2006)
Administrative Analysis of Prenatal Data Final Report (Oklahoma Foundation for Medical Quality, 2006)
Tulsa County Profile 2007 (Tulsa Health Department, 2007)
Community Profile of Tulsa County 2007 (Community
Service Council, 2007)
Preliminary Findings 2004 Infant Deaths (Tulsa Health
Department, 2007)
Babyline 1990-2004 Trend Report (Community Service Council,
2006)
Administrative Analysis of Prenatal Data Final Report (Oklahoma Foundation for Medical Quality, 2006)
Tulsa County Profile 2007 (Tulsa Health Department, 2007)
Community Profile of Tulsa County 2007 (Community
Service Council, 2007)
Preliminary Findings 2004 Infant Deaths (Tulsa Health
Department, 2007)
Prepared by the Community Service Council of Greater Tulsa
Infant Mortality RatesTulsa County and Oklahoma, 1980-2005
Source: Oklahoma State Department of Health
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
0
2
4
6
8
10
12
14
Number of infant deaths per 1,000 live births
Tulsa County
Oklahoma
Tulsa County 11.8 13.3 11.1 10.9 9.6 10.5 9.3 8.4 10.3 9.6 9.7 9.9 8.6 11.1 10.2 9.7 9.4 7.3 7.5 7.7 9.9 7 8.8 7.5 6.6 8.2
Oklahoma 13.4 12.4 13.4 10.6 10 10.2 9.3 8.5 8.3 8.1 9.2 9.5 8.7 8.7 8.7 8.6 8.7 7.7 8.9 8.7 8.8 7.5 8.1 7.9 7.9 8.1
In 2005, there were 76 infant deaths in Tulsa County, for rate of 8.2 per 1,000 live births; in the state, there were 418 infant deaths, for a rate of 8.1
“Healthy People 2010” goal = 4.5 per 1,000
Infa
nt M
orta
lity
Tulsa County, All Eligible Babies, 1996-2000, Feto-Infant Deaths grouped
by Maternal RaceMaternal Health/ PrematurityWhite, NonHisp = 2.31 (70)African American= 4.02 (26)Native American = 2.18 (6)Hispanic= 4.65 (16)Other= 0
Maternal CareWhite, NonH= 1.29 (39)Afr. Amer.= 2.63 (17)Nat. Amer. = 1.82 (5)Hispanic= 9.00 (31)Other= 3.62 (3)
Newborn CareWhite, NonH= 1.52 (46)Afr. Amer.= 2.16 (14)Nat. Amer. = 1.09 (3)Hispanic= 0.87 (3)Other= 2.41 (2)
Infant HealthWhite, NonH= 1.42 (43)Afr. Amer.= 2.94 (19)Nat. Amer. = 2.54 (7)Hispanic= 1.74 (6)Other= 1.21 (1)
Maternal Race
Cumulative IMRs:
White, NonHsp=6.54
Afr. Amer.=11.75
Nat. Amer.= 7.63
Hispanic= 16.26
Other= 7.24
Excluded: 38 live births w/out race data; 5 deaths, 442 births missing HispEthnicity; 130 with data outside PPOR criteria PPORt Dataset
3/24/04
Tulsa Fetal-Infant Mortality Review
Tulsa Fetal-Infant Mortality Review
Tulsa’s Perinatal System CapacityTulsa’s Perinatal System Capacity
Social MarketingSocial Marketing
Client
Outreach Case Finding Free Pregnancy Testing Planline/Family Planning
Babyline/Risk Assessment/Case Management Referral
CHC IHCRC Morton OSU OB/GYN
OU Family Med
PP THD
High Risk Care
Low and Moderate Risk Care
MortonPrivate Doctors
OSUOU
OB/GYN
Deliveries
OSU
Med CtnrSouthcrestHillcrest
Postpartum & Family Planning
CHC MortonIHCRC OSUOU Family
MedPP THD
Evidence Based StrategiesEvidence Based Strategies
Outcome performance measures Community coalitions
Collaborative, public-private partnerships Consumer/client investments
Outreach and recruitment Services (prenatal, family planning, women’s
health) Case management/Care coordination Social marketing Risk reduction education Access to services and care
Child care Transportation Translation
Outcome performance measures Community coalitions
Collaborative, public-private partnerships Consumer/client investments
Outreach and recruitment Services (prenatal, family planning, women’s
health) Case management/Care coordination Social marketing Risk reduction education Access to services and care
Child care Transportation Translation
Navigating Tulsa’s Perinatal System Navigating Tulsa’s Perinatal System
Social MarketingSocial Marketing
Client
Outreach Case Finding Free Pregnancy Testing Planline/Family Planning
Babyline/Risk Assessment
CHC IHCRC Morton OSU OB/GYN
OU Family Med
PP THD
High Risk Care
Safety Net/ Low and Moderate Risk Care
MortonPrivate Doctors
OSUOU
OB/GYN
Deliveries
OSU
Med CtnrSouthcrestHillcrest
Safety Net/Post-partum & Family Planning
CHC MortonIHCRC OSUOU Family
MedPP THD
Service
•Uninsured pool for prenatal care
•High risk obstetrical care stabilized
•Family planning for the uninsured
Access
•Expansion of all 3 case management
programs
•Expansion of risk appropriate referrals (Housing, Grieving support, translation,
smoking cessation, etc)
Preconceptional & Interconceptional Care
•Education
•Babyline & Planline
•Free Pregnancy Testing Program
•Social marketing
•Teen pregnancy prevention$2,173,980 annual
$3,781,433 annual
$1,464,730 annual
Est. $12M endowed
$1,454,149 annual
$1,513,280 annual
Research
•TFIMR
•Women’s Health Research
Center$1,399,879 annual
Wild CardsWild Cards
HB 1804 Immigration BillUnborn Child LegislationMedicaid for dental coverage
during pregnancyDecrease in Title V funding
HB 1804 Immigration BillUnborn Child LegislationMedicaid for dental coverage
during pregnancyDecrease in Title V funding
Prepared by the Community Service Council of Greater Tulsa
Summary of Risk Factors for InfantsTulsa County and Oklahoma, 2005
Source: Oklahoma State Department of Health, Vital Statistics.
11.6%
41%
7%
24.6%
6.3%
1.6%
33.5%
19.2%
11%
12.9%
39.1%
5.6%
22.4%
6.6%
1.4%
32.8%
19.1%
10.6%
Teen mother(age 15-19)
Unmarried mother
Poor prenatal care(3rd trimester/no care)
Mother w/ <12th gradeeducation
Low birthweight(1500-2499 grams)
Very low birthweight(<1500 grams)
Short birth spacing(<24 mos. apart)
Very short birth spacing(<18 mos. apart)
Premature(<37 weeks gest.)
0% 10% 20% 30% 40% 50%
Percent of Births
Tulsa Co.
Oklahoma
Tulsa County births: 9,297Oklahoma births: 51,775
Ris
k F
acto
rs fo
r In
fant
s
Prepared by the Community Service Council of Greater Tulsa
Characteristics of Births to Teen Mothers (Age 15-19)Tulsa County and Oklahoma, 2005
Source: Oklahoma State Department of Health, Vital Statistics.
84%
11.2%
63.4%
7.8%
2.4%
64%
40.1%
11.4%
23%
3.6%
78.4%
8.5%
54.9%
7.6%
1.8%
64.8%
42.9%
10.6%
20.9%
3.5%
Unmarried
Poor prenatal care(3rd trimester/no care)
Mother w/ <12th gradeeducation
Low birthweight(1500-2499 grams)
Very low birthweight(<1500 grams)
Short birth spacing(<24 mos. apart)
Very short birth spacing(<18 mos. apart)
Premature(<37 weeks gest.)
1+ previous births
2+ previous births
0% 20% 40% 60% 80% 100%
Percent of Teen Births
Tulsa Co.
Oklahoma
Tulsa County births to teens: 1,080Tulsa County teen birth rate: 57.8 (per 100,000 females age 15-19)
Oklahoma births to teens: 6,682Oklahoma teen birth rate: 54.2 (per 100,000 females age 15-19)
Ris
k F
acto
rs fo
r In
fant
s
Prepared by the Community Service Council of Greater Tulsa
Teen Mothers and Poor Birth Outcomes
Source: Oklahoma State Department of Health, Maternal, Infant and Child Health, 1997 Selected Demographic Information.
Risk Factor Teen Moms
Oklahoma ranked 8th in the nation in rate of births to teens in 2002.
42% higher20% lower81% higher86% higher2.7 times higher2.3 times higher23% higher30% higher
Low birth weight1st Trimester prenatal care3rd Trimester prenatal care
No prenatal careUnmarried
Short interval births (<24 months)Premature births (>3 weeks early)
Birth complications
Women under age 20, "teens," are more at risk of poor birth outcomes than are women age 20 & older.
Bir
ths
to T
eens
Prepared by the Community Service Council of Greater Tulsa
Resident Births by Marital Status of MotherTulsa County, 1980, 1990, 2000 and 2005
Source: Oklahoma State Department of Health.
7,143
6,6046,221
5,482
1,406
2,253
3,110
3,813
1980 1990 2000 20050
2,000
4,000
6,000
8,000
Number of births
Single Married
% Single 16.4 25.4 33.3 41
% Married 83.6 74.6 66.7 59Ris
k F
acto
rs fo
r In
fant
s
Prepared by the Community Service Council of Greater Tulsa
Resident Births, by Trimester of Entry into Prenatal CareTulsa County, 1980, 1990, 2000 and 2005
Source: Oklahoma State Department of Health, Vital Statistics.
64.2%
24.6%
9.0%
2.3%
69.6%
21.7%
6.9%1.7%
73.0%
18.9%
5.6%2.5%
70.3%
21.5%
6.9%1.3%
1st trimester 2nd trimester 3rd trimester or no care Unknown
1980 1990
2000 2005Ris
k F
acto
rs fo
r In
fant
s
Prepared by the Community Service Council of Greater Tulsa
Resident Births, by Trimester of Entry into Prenatal CareTulsa County, 1980, 1990, 2000 and 2005
Source: Oklahoma State Department of Health, Vital Statistics.
64.2%
24.6%
9.0%
2.3%
69.6%
21.7%
6.9%1.7%
73.0%
18.9%
5.6%2.5%
70.3%
21.5%
6.9%1.3%
1st trimester 2nd trimester 3rd trimester or no care Unknown
1980 1990
2000 2005Ris
k F
acto
rs fo
r In
fant
s •HIPAA barrier on transfer of medical records at 36 weeks
•Hispanic culture and self-pay
•Inadequate Medicaid global fee