The Perinatal Periods of Risk Approach

1. The Perinatal Periods of Risk Approach Ten Things You Should Know Jennifer Skala, MEd CityMatCH 2003 Healthy Start Grantee Meeting

2. CityMatCH Mission Improving the health and well-being of urban women, children and families by strengthening public health organizations and leaders in their communities.

3. CityMatCH PPOR Activities To develop and advance the practice of the PPOR approach as a community tool to improve the health of womenand infants

4. The PPOR Urban Learning Network To strengthen local public health capacity for improving perinatal health through the effective use of the PPOR approach. • How to Do PPOR workshops • Distance Seminars • Technical Assistance • Peer Exchange

5. 10 Things You Should Know about the PPOR Approach

6. PPOR is acomprehensive approachused to address feto-infant mortality PPOR analysis is the starting point not the ending point

7. 2)The PPOR Data allow you to look at feto-infant mortality in new ways • Includes Fetal and Infant Deaths (> 24 weeks) • Focuses on VLBW (< 1,500 grams) • Generates a “Map” for targeting strategic actions • Examines birthweight and gestational age at the same time

8. Infant Mortality Rate,Urban County, 1990-2001 * White rate for 2001 is provisional Source: DHHS

9. Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health PPOR “Map” fetal & infant deaths Age at Death Fetal Death Post- neonatal Neonatal Birthweight 500-1499 g 1500+ g

10. 3)It brings community partners together to build consensus, support, and partnership Provides a framework for discussing the problem

11. 4)It allows a Community to move toward ACTION! Maternal Health/ Prematurity Preconceptional Health Health Behaviors Perinatal Care Prenatal Care High Risk Referral Obstetric Care Maternal Care Perinatal Management Neonatal Care Pediatric Surgery Newborn Care Sleep Position Breast Feeding Injury Prevention Infant Health

12. 5)It’s more than rates and numbers, it allows a community to focus on the Gaps: • ASK: Which women/infants have the "best" outcomes? • ASSUME: all infants can have similar “best” outcomes • CHOOSE: a comparisongroup(s) (‘reference group’) who already has achieved “best” outcomes • COMPARE: fetal-infant mortality rates in your targetgroup with those of the comparison group(s) • CALCULATE:excessdeaths (= target – comparison groups). This is your community’s “Opportunity Gap.”

13. 6)PPOR provides a framework for targeting further investigations and actions • Phase 1:Identifies the populations with overly high numbers and rates of mortality. • Phase 2:Explains why the excess deaths.

14. Maternal Health/ Prematurity Infant Health Where and Why the excess deaths? Women’s Health vs. NICU survival Causes of Death

15. 7)PPOR Fosters integrationwith other key efforts • Previous assessments • Previous perinatal studies or surveillance • Mortality Reviews • PRAMS or other surveys • Health system assessments • Asset mapping • Previous policy and program evaluations “Paint the faces behind the numbers”

16. Critical Integration Perinatal Periods of Risk Fetal and Infant Mortality Reviews Local Health Action Plan

17. 8) You need to be ready analytically to do the PPOR approach • Fetal death files (no gest. age restrictions) • Linked birth—infant death certificate files • Unlinked infant death certificate files • Key data items missing or poor quality

18. 9)You need the CommunityOnboard and Ready Champions, Leadership and Adequately Trained Staff that: • Understands the feto-infant mortality problem • Understands the work plan • Commits to providing resources for the investigation • Commits to providing resources for community collaboration • Gives priority and champions the initiative

19. 10) PPOR is about impact and results: • Builds data and epi capacity • Promotes effective data use • Strengthens essential partnerships • Fosters integrationwith other key efforts • Encourages evidence-based interventions • Helps leverage resources • Enables systems change for perinatal health

20. Headline News… • Locally-defined disparities serve to target further investigations and tailor prevention • Philadelphia PA • Successful integration of PPOR, FIMR, Healthy • Start yields better prevention of feto-infant deaths • Louisville KY • Stronger local/state partnership builds better • data capacity to address health disparities • Columbus OH

21. Headline News… • PPOR Reenergized the Community to Prioritize Actions • Pittsburgh, PA • Using PPOR and FIMR to Focus Efforts and Resources • Jacksonville FL

22. 10 Things You Should Know: • PPOR is acomprehensive approach used to address feto-infant mortality • The PPOR Data allow you to look at feto-infant mortality in new ways • It brings community partners together to build consensus, support, and partnership • It allows a Community to move toward ACTION! • It’s more than rates and numbers, it allows a community to focus on the Gaps • PPOR provides a framework for targeting further investigations and actions • PPOR Fosters integrationwith other key efforts • You need to be ready analytically to do the PPOR approach • You need the Community to be Ready to do the PPOR approach • PPOR is about impact and results

23. PerinatalPeriodsofRisk: For More Information: www.citymatch.org “How to Do” PPOR workshop Dec 12 and 13 In conjunction with MCH EPI Conference in Tempe, AZ