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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
Data provided by KDHE
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%)
Data provided by KDHE
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%)
Data provided by KDHE
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 *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
NEWHSI Zip Codes versus other Sedgwick County zip codes
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
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.
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
Sedgwick County IMR financial supporters:
Central Plains Regional Health Care Foundation Healthy Babies Program• NEWHSI grant• CDC Safe Motherhood grant
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
Authority to perform abstraction activities and to review abstracted case summaries has been reviewed by KDHE and SCHD legal staff
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
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.
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
NFIMR recommends:
• Media sub-committee• Annual FIMR report
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Develop Programmatic Features
Currently managed by SCHD staff:
Susan Wilson, Healthy Babies Program Manager
Ty Kane, Community Health Analyst
Define the Community
Determine relationship to other review processes
Identify costs and funding sources
Identify and address legal and institutional issues
Set up procedures and policies
Reporting to community
Administrative functions
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
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
Build Community Support and Collaboration
Determine the sponsoring agency
Build support from community services
Identify FIMR team participants
Hold town hall meeting
Develop mission statement
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
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
Build Community Support and Collaboration
Determine sponsoring agency
Build support from community services
Identify FIMR team participants
Hold town hall meeting
Develop mission statement
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
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
Build Community Support and Collaboration
Determine sponsoring agency
Build support from community services
Identify FIMR team participants
Hold town hall meeting
Develop mission statement
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Planning team will consider some type of kick-off or community engagement event
Build Community Support and Collaboration
Determine sponsoring agency
Build support from community services
Identify FIMR team participants
Hold town hall meeting
Develop mission statement
* INITIATE FIMR CASE REVIEWS *
Essential Steps for Initializing a FIMR ProgramSource: NFIMR, “A Guide for Communities, FIMR Manual, 2nd Edition”
* ASSURE COMMUNITY READINESS *
Yet to be finalized.
.. will be guided by diversity, commitment and consumer participation.
Build Community Support and Collaboration
Determine sponsoring agency
Build support from community services
Identify FIMR team participants
Hold town hall meeting
Develop mission statement
* INITIATE FIMR CASE REVIEWS *
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]