Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Topeka, Kansas

1. Kansas Blue Ribbon Panelon Infant MortalityAugust 28, 2009Topeka, Kansas

2. Mother & Child Health Coalition Susan McLoughlin, MSN, RN, CPNPExecutive DirectorJean Craig, PhDKansas City Healthy Start Project DirectorMary Jean Brown, MS, RNCKansas City FIMR Program Coordinator

3. Maternal & Child Health Coalition of Greater Kansas City, Inc.

4. Our Vision Every mother and child in greater Kansas City will be healthy.

5. The five county metropolitan area includes: • Wyandotte and Johnson counties in Kansas • Jackson, Clay and Platte counties in Missouri

6. Our Mission

7. Every child deserves a healthy start. It is the best gift a community gives its children and itself.  

8. Mother & Child Health Coalition works together with community partners and families to promote wellness and advocate excellence in health care.

9. History • Numerous organization partners and individuals • Organizational Chart • Committees, Programs and Projects

10. HEALTHY PEOPLE 2010

11. Process GoalsGoal 1 • Promote the involvement of multiple organizations in the delivery of health and prevention services; and • facilitate a more comprehensive health care delivery system to women of childbearing age, infants and children, specifically targeting services to those women at risk of adverse pregnancy outcomes.

12. Goal 2 • Increase the availability, ease of access, and utilization of health services for women of childbearing age and children; • decrease health disparities between racial and/or socioeconomic groups; and • improve the quality of life for women, infants and children.

13. Goal 3 Optimize maternal/child health outcomes through: • health promotion and injury prevention services; • responsible sexuality; • medical care before, during and after pregnancy; • educational and emotional preparation for parenting, including financial responsibility.

14. 5 Priority Issue Areas • INFANT MORTALITY • IMMUNIZATIONS • INJURY PREVENTION • CHILDHOOD OBESITY • BREASTFEEDING

15. Resource Sharing • Networking • Dissemination of Best Practices • Annual Report

16. Jean Craig, PhDProject DirectorKansas City Healthy Start

17. 15 ZIP Codes Children’s Mercy Hospital – English/Hispanic Truman Medical Center,Hospital Hill Project EAGLE Truman Behavioral Health KCHS Sites: Missouri & Kansas

18. Components: • Outreach • Case Management • Health Education • Perinatal Depression Screening • Interconception Care • Fathering Initiative (BB Clinic/Workshop)

19. Sista’ Talk (English/Spanish) – RAP Talk Policy Council/Peer Group – Early Head Start (1x per mo/educational topics/taxes/WIC) Business Meetings -Pres/VP/Sec Gentlemen of The Round Table ( Maltbia/Jones) Letters of Recommendation for Education/Employment Bi-Monthly Consumer Training Graduate Speaker Bureau Leadership Support

20. Partnerships: • Local Universities/Lincoln University Extension Program • Full Employment Council • Health Dept/Health Centers • Gentlemen of The Roundtable • The Clay Johnson Foundation • Nat’l Center for Fathering • StartRight Teen MOMs/DADs • Faith-Based Organizations

21. In-Kind: • Target • Kiwanis • Babies R Us • Community

22. Dedicated Dads • Male Involvement • Committee • StartRight Teens w/TMC • KC Magic Weekend (Workshop/BB Clinic)

23. Data Profile: • African American – 60% • Hispanic – 30% • Caucasian – 5% • Other – 5%

24. Performance Objective: • Prenatal Visits: CY 2005: 99/120 (82.5%) – Obj. 85.0 CY 2006: 81/97 (83.5%) – Obj. 90.7 CY 2007: 97/114 (85.1%) – Obj.85.0 CY 2008: 67/86 (83.7) – Obj.85.0

25. Performance Objective: • Very Low Birth Weight: CY 2005: 0/100 (0%) – Obj. 3.6% CY 2006: 1/58 (1.7%) – Obj. 2.5% CY 2007: 1/47 (2.1%) – Obj. 2.0% CY 2008: 1/67 (1.5%) – Obj. 1.5%)

26. Performance Objective: • Low Birth Weight CY 2005: 0/28 (0%) – Obj. 1.4% CY 2006: 7/28 (12.1%) – Obj. 1.4% CY 2007: 4/47 (8.5%) - Obj. 1.4% CY 2008: 6/59 (10.2%) - Obj. 1.4%

27. Performance Objectives: • IMR (# deaths x 1000 div. by # live births) CY 2005: 0/28 (0%) – Obj. 28.8 CY 2006: 1/58 (17.2%) – Obj. 20.0 CY 2007: 1/47 (21.3%) - Obj. 15.0 CY 2008: 1/67 (14.9%) - Obj. 15.0

28. Mary Jean Brown, MS, RNCProgram CoordinatorGreater Kansas City’s Fetal Infant Mortality Review Program

29. History of FIMR 1990 • FIMR was a collaborative effort between • Federal Maternal and Child Health Bureau (MCHB) and • The American College of Obstetricians and Gynecologists (ACOG) • Created as a strategy to improve service systems and resources for women, infants and families.

30. Purpose of FIMR • To improve services systems and resources for women, infants and families • Address gaps in care • Understand how psychosocial and economic issues affect outcomes

31. FIMR Partners • Missouri Department of Health and Senior Services • Kansas City Missouri Health Department • March of Dimes • St. Luke’s Fetal Board • SIDS Resources • Mother and Child Health Coalition • Kansas City Healthy Start Program

32. FIMR Process • Death Occurs • Data Collected • Death certificate, prenatal records, inpatient records, social work notes, maternal interview • Case Review Team reviews de-identified cases and makes recommendations to: • Community Action Team • Responsible for Interventions & System changes • Improved Maternal and Infant Health

33. KC FIMR • Fetal and Infant deaths from 5 ZIP codes in Kansas City, MO are reviewed • Majority of births are at 3 inner city hospitals: • Truman Medical Center • St. Luke’s Hospital, Plaza Campus • Research Medical Center • 73 cases have been reviewed September 2004 to April 2009

34. Definitions • Fetal Mortality • 20 weeks gestation or greater • Or at least 350 gms • Infant Mortality • Death of live born infant before his or her first birthday

35. KCFIMR Race/Ethnicity FIMR Kansas City, MO (n=73) (n=7,858) AA 87.6% 36.5% Hispanic 9.5% 16.0% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

36. KC FIMR Age Distribution FIMR Kansas City, MO (n=73) (n=7,858) • Age <20 16.4% 12.6% • Age 20-34 71.2% 77.3% • Age 35+ 12.3% 10.1% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

37. KC FIMR Prenatal Care FIMR Kansas City, MO (n=73) (n=7,858) Adequate 26% 84.6% Marginal 24.6% 12.3% Inadequate 30.1% 3.10% FIMR cases September ’04 to April ’09 Kansas City, MO live birth data, 2006

38. KC FIMR BMI Category FIMR KCMO (n=73) (n=7,858) Normal Weight 30.1% 44.4% Underweight 2.7% 3.9% Overweight 26.0% 21.1% Obese 32.8% 19.5%

39. KC FIMR Preexisting Disease FIMR Kansas City, MO (n=73) (n=7,858) Diabetes 5.10% 0.50% Hypertension 12.3% 0.90% Obesity 32.8% 19.5% Tobacco 35.6% 12.5% Alcohol 10.9% 0.50% Drug use 23.2% 1.20% Asthma 21.9%

40. KC FIMR Identified Trends • Limited or No Prenatal Care • Addiction to alcohol, tobacco, drugs • Obesity • Asthma

41. FIMR Community Action Team • CAT is part of the Kansas City Health Commission: Women’s Infant’s and Children’s Committee • CAT puts action steps to the recommendations from the CRT, based on identified trends.

42. CAT Activities Access to Care Issues Seeking to reduce barriers to early entry into care • Identifying potential KC community partners • Seeking funding sources • Found vendors to donate pregnancy tests

43. Public Awareness of FIMR • Kansas City Gyn Society Meeting, 2009 • David Mundy, MD, Perinatologist, TMC, Chair of CRT • History and activities of FIMR • Data presentation • Invitation to join Community Action Team or Case Review Team

44. Missouri-Kansas Partnership • KC Healthy Start Program contracted with Kansas Department of Health and Environment for a FIMR-like program • Wyandotte County, Kansas • 44 Fetal and Infant deaths (2005) abstracted • Sedgwick County, Kansas (2005)

45. We appreciate all you do to help see that every child receives a Healthy Start! THANK YOU!