1 / 42

Kansas City, Missouri Health Department Perinatal Periods of Risk Practice Collaborative Jinwen Cai, MD Josie M. Manning

Kansas City, Missouri Health Department Perinatal Periods of Risk Practice Collaborative Jinwen Cai, MD Josie M. Manning, RNC, MS. KCMO Health Department Strategic Priorities. Eliminating Health Disparities. Infant Mortality Immunization C & A HIV/AIDS/STD Cardiovascular Disease

leighna
Download Presentation

Kansas City, Missouri Health Department Perinatal Periods of Risk Practice Collaborative Jinwen Cai, MD Josie M. Manning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Kansas City, Missouri Health Department Perinatal Periods of Risk Practice Collaborative Jinwen Cai, MD Josie M. Manning, RNC, MS

  2. KCMO Health Department Strategic Priorities Eliminating Health Disparities • Infant Mortality • Immunization C & A • HIV/AIDS/STD • Cardiovascular Disease • Injury Prevention

  3. Infant Mortality Rates Kansas City, MO. 1991-2000

  4. Low Birthweight Births Kansas City, MO. 1991-2000 Objectives

  5. Fetal Deaths, Infant Deaths and Live Births for PPOR Target Area for the Years of Study Target Area: Kansas City, Missouri Year: 1996-2000 Fetal Deaths (24+wks) Neonatal Deaths Post-neonatal Deaths Live Births 500 to 1,499 grams 60 79 11 588 1,500+ grams 71 49 110 34,944 There were 380 feto-infant deaths occurred in Kansas City, Missouri during 1996-2000. Approximately 250 infant deaths with the weight of 500 grams or above were found at the same period of time. Birthweight Neonatal infant deaths occur during the first 27 days of life and post-neonatal infant deaths occur between 28 and 364 days of age.

  6. Infant Mortality Rates, KCMO 1996-2000 *Non-Hispanic white women greater than 19 years of age with more than 12 years of education.

  7. Percentage of Excess Feto-Infant Mortality, KCMO. 1996-2000 Total Excess Deaths =176 Using internal reference

  8. Feto-Infant Mortality: Birthweight Distribution, KCMO. 1996-2000

  9. Feto-Infant Mortality: Birthweight-Specific Mortality Rates, KCMO. 1996-2000

  10. Feto-Infant Mortality: Contribution of the Birthweight Distribution and Birthweight-Specific Mortality KCMO. 1996-2000 B. Maternal Health/Prematurity Excess Rates A. Overall Excess Rates

  11. Fetal Deaths, Infant Deaths and Live Births for PPOR Target Area for the Years of Study Target Area: African American Population in Kansas City, Missouri Year: 1996-2000 Fetal Deaths (24+wks) Neonatal Deaths Post-neonatal Deaths Live Births 500 to 1,499 grams 31 44 9 316 1,500+ grams 37 23 66 12,479 Birthweight

  12. African American Infant Mortality Rates, KCMO 1996-2000 *Non-Hispanic white women greater than 19 years of age with more than 12 years of education.

  13. Percentage of Excess African American Feto-Infant Mortality, KCMO. 1996-2000 Total Excess Deaths =137 Using internal reference

  14. Feto-Infant Mortality: Birthweight Distribution-African AmericansKCMO. 1996-2000

  15. Feto-Infant Mortality: Birthweight-Specific Mortality Rates-African AmericansKCMO. 1996-2000

  16. Feto-Infant Mortality: Contribution of the Birthweight Distribution and Birthweight-Specific Mortality-African Americans KCMO. 1996-2000 B. Maternal Health/Prematurity Excess Rates A. Overall Excess Rates

  17. Infant Causes of Death KCMO 1996-2000 Category VLBW LBW NBW Total SIDS 1 8 49 58 Perinatal Conditions 73 8 9 90 Congenital Anomalies 10 19 24 53 Unintentional Injuries 1 4 7 12 Intentional Injuries 0 1 8 9 Other 5 7 15 27 Total 90 47 112 249

  18. Infant Mortality Rates by Mother Age and Previous Births, KCMO. 1996-2000 *There were 7 infant deaths and 310 live births for those women who had previous births and 29 infant deaths and 1926 live births for those women who did not have previous births.

  19. SIDS Rates by Mother Age KCMO. 1996-2000

  20. Selected Characteristics and Risk Factors KCMO 1996-2000 Risk factors Infant Deaths Live Births P & Characteristics Value Sample size 249 35532 Age, <20 years 24.5 15.9 0.000 Education, <13 years 64.7 50.3 0.000 Race, African American 57.5 36.1 0.000 Marital status, No69.9 48.1 0.000 Gender, Boy 62.7 50.7 0.000 Smoking, Yes 24.5 15.7 0.000 Prenatal care, Adequate care 55.0 75.3 0.000 Never 6.0 1.5 0.000 Trimester care began, First 68.3 81.3 0.000 Medical risks, Any 46.2 27.3 0.000 Birth spacing<18 months 18.8 7.1 0.000 Previous births, Yes63.9 59.1 0.132 Any drinks, Yes2.4 1.5 0.241 Selected birth weight with 500 grams or above for both infant deaths and live births group.

  21. Selected Characteristics and Risk Factors For Women During Pregnancy KCMO 1996-2000 Risk factors SIDS Live Births P & Characteristics Value Sample size 5734940 Age, <20 years 29.8 15.7 0.004 Education, <13 years 76.4 53.9 0.000 Race, African American 56.1 35.7 0.001 Marital status, No78.9 47.8 0.000 Gender, Boy 70.2 50.6 0.003 Previous births, Yes 77.2 59.1 0.006 Smoking, Yes 42.1 15.6 0.000 Prenatal care: Adequate care 60.0 79.1 0.000 Prenatal care: Never 5.6 1.5 0.015 Birth spacing<18 months 22.5 7.1 0.000 Any drinks, Yes1.8 1.5 0.858 Trimester care began, First 77.8 84.9 0.131 Medical risks, Any33.3 26.6 0.249 Selected birth weight with 1,500 grams or above for both infant deaths and live births group.

  22. Selected Characteristics and Risk Factors For Black Women During Pregnancy KCMO 1996-2000 Risk factors SIDS Live Births P & Characteristics Black Births Value Infants Sample size 36 11457 Marital status, No 94.4 78.6 0.020 Gender, Boy 69.4 50.0 0.020 Smoking, Yes 41.7 13.3 0.000 Prenatal care, Adequate care 54.0 69.4 0.064 Selected birth weight with 1,500 grams or above for both infant deaths and live births group.

  23. Smoking Rates For Women During Pregnancy KCMO 1996-2000

  24. Number and Location of Infant Deaths by ZIP Code KCMO 1996-2000 Center city with 9 ZIP Codes had 111 infant deaths out of 249 deaths (44.6%). The average age at birth was 23 years compared with 26 years of the rest of the city. There was a significant difference at level 0.001 (p=0.0007).

  25. Infant Mortality Rates by ZIP Code KCMO 1996-2000

  26. Median Household Income by ZIP Code, KCMO 1999

  27. Sudden Infant Death Syndrome Area % ZIP Code 64127 & 64130, 1996-2000 34.8 Kansas City Missouri, 1996-2000 22.9 State of Missouri, 2000 11.9 U.S., 1997 10.7 SIDS accounted for 34.8% (16) of all infant deaths (46) occurred in those two ZIP Codes. No prenatal care was 14.3% in the same ZIP Codes, compared with 5.6% in Kansas City Missouri.

  28. Sudden Infant Death Syndrome Risk factors ZIP Codes KCMO & Characteristics 64127 & 64130 SIDS Births SIDS Births Sample size 16 4292 57 34940 Age, <20 years 50.0 28.5 29.8 15.7 Education, <13 years 100.0 79.2 76.4 53.9 Race, African American 68.8 77.0 56.1 35.7 Marital status, No100.0 79.1 88.9 52.2 Gender, Boy 68.8 50.9 70.2 50.6 Previous births, Yes 81.3 64.2 77.2 59.1 Any drinks, Yes 0.0 2.5 1.8 1.5 Smoking, Yes 37.5 19.5 42.1 15.6 Prenatal care, Adequate care 43.8 66.4 60.0 79.1 Never 14.3 3.1 5.6 1.5 Trimester care began, First 78.6 75.8 77.8 84.9 Medical risks, Any 31.3 34.0 33.3 26.6 Birth spacing<18 months 30.0 10.7 22.5 7.1

  29. Infant Mortality PreventionRecommendations: • Guarantee universal coverage and access to services for prenatal care, including outreach, transportation, and translation, service for non English speakers • 2. Increase availability of services by opening more school-based clinics and utilizing nurse practitioners and nurse midwives; • 3. Organize services to make everything available in one location place if possible; Provide full coverage for all recommended well-baby examinations;

  30. Infant Mortality PreventionRecommendations: cont. • Include more specialists in managed health care plans for at-risk pregnant women and infants with special needs; • Increase interventions to reduce teen pregnancies; • Ensure all prenatal care providers address smoking risk during pregnancy; • Provide education and counseling aimed at preventing preterm delivery and very low birthweight; • Reduce number of low birthweight and very low birthweight babies.

  31. Who Should Participate in PPOR? Using the FIMR Model • Key Community Leaders • Health Care Providers • Public Health Providers • Human Service Providers • Advocates and Consumers

  32. Taking PPOR to the Community Community Engagement • 238 Information Packets sent out • The distribution list was determined according to the FIMR model • Responses were received from nearly 150 people

  33. Community Presentations • Maternal & Child Health Coalition of Greater KC • Infant-Child-Pregnancy Committee • Head Nurses from Area Hospital Nurseries • Community Wide Forum • National Forum for Black Public Administrators (Portland, Oregon)

  34. The Community Wide Forum • Over 70 individuals attended the first forum • 47 different organizations represented • Media Alert • Received TV and newspaper coverage • New members joined the PPOR team

  35. Organizations Represented • Leading Area Hospitals and Care Providers • Area’s Largest Health Insurance Organizations • Medical and Nursing Schools • Local Universities and School Districts • Community and Social Service Agencies • City, County, State and Federal Governments • Faith Community • Mental Health Organizations • Media

  36. Media CoverageGetting the Word Out • Media Alerts • Television reports • Newspaper article

  37. What People Say About PPOR • It’s overwhelming. • This is only the tip of the iceberg. • The statistics were interesting and I’ll use them in my practice. • It gives recognition of the root causes of infant mortality via data. • The data presentation focused the group sessions. • Focus groups bring forth best experiences and ideas. • The mixture of organizations and individuals is helpful. • It’s a large group with a common cause coming together. • It makes us aware of how many of us care.

  38. Other PPOR Data Applications • Racial-ethnic • Development of a FIMR • Grant inquiries and applications • Teen pregnancy

  39. Sudden Infant Death Syndrome Rate Among Teen Mothers Aged 15-19 Years by Race & Ethnicity, KCMO 1996-2000

  40. Where Do We Go From Here? • Another meeting on 4/25/02 • PPOR Summit on 5/30 – Speakers from CityMatCH and other partnering cities • Development of strategies and best practices • Dissemination of information • Putting it all into practice • Follow-up analysis • Refine or rethink strategies

  41. Dr. Jinwen Cai - 816-513-6044 Jinwen_Cai@kcmo.org Josie M. Manning – 816-513-6091 Josie_Manning@kcmo.org

More Related