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AMCHP 2005

The Perinatal Periods of Risk Approach (PPOR) From Data to Action to Improve Women and Infants’ Health. AMCHP 2005. City M at CH Mission. Improving the health and well-being of urban women, children and families by strengthening public health organizations and leaders

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AMCHP 2005

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  1. The Perinatal Periods of Risk Approach (PPOR)From Data to Action to Improve Women and Infants’ Health AMCHP 2005

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

  3. PPOR is a six step approach used to address feto-infant mortality

  4. 6 Basic Steps:Perinatal Periods of Risk Approach Step 1: Assure Analytic and Community Readiness Step 2: Conduct Analytic Phases of PPOR Step 3: Develop Strategic Actions for Targeted Prevention Step 4: Strengthen Existing and/or Launch New Prevention Initiatives Step 5: Monitor and Evaluate Approach Step 6: Sustain Stakeholder Investment and Political Will

  5. Step 1: Assure Analytic and Community Readiness Provides a framework for discussing the problem

  6. You need to be analytically ready to do the PPOR approach • Fetal death files (no gest. age restrictions) • Linked birth—infant death certificate files • Unlinked infant death certificate files • Critical number of Events (n=60) • Key data items missing or poor quality

  7. You need the Community Onboard 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

  8. Community Readiness:From Concepts to Tools • Leadership • Partnership • Commitment • Change RAISING THE ROOF FOR PPOR: What Shape Is Your Tent?

  9. Step 2: Conduct Analytic Phases of PPOR • Includes Fetaland Infant Deaths(> 24 weeks) • Focuses on VLBW(< 1,500 grams) • Generates a “Map” for targeting strategic actions • Examinesbirthweightand gestational age at the same time

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

  11. 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

  12. Maternal Health/ Prematurity Preconception 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 It allows a Community to move toward ACTION!

  13. PPOR PHASE 1: “Map and Gap” • Phase 1:Identifies the populations with overly high numbers and rates of mortality. • Phase 2:Explains why the excess deaths.

  14. 97/ 4.2 Maternal Health/ Prematurity (35 fetal deaths, 62 live births) 48/2.1 Maternal Care (fetal deaths) 44/1.9 Newborn Care (live births) 47/2.0 Infant Health(live births) Map of Fetal-Infant Deaths Urban County, All Races2000-2002 236 Fetal-Infant Deaths 23,282 live births and fetal deaths = 10.2 overall rate

  15. White Fetal-Infant Rate =8.6 (N=16,045) Black Fetal-Infant Rate =17.6 (N=3,291) 3.1 8.8 2.0 1.9 1.6 2.4 2.4 4.0 White non-Hispanic Black non-Hispanic PPOR Map of Feto- Infant MortalityUrban County, By Race, 2000-2002(N=number of live births and fetal deaths)

  16. 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.”

  17. 2.2 1.1 1.0 1.5 National PPOR Initiative “External” Reference Group • Defined by maternalcharacteristics • 20 or more years of age • 13 or more years of education • Non-Hispanic white women • mothers who at the time of the baby’s birth were residents of cities or counties with populations over 250,000 and no major reporting problems. Total Fetal-Infant Mortality Rate=5.9

  18. ExcessFetal-Infant Mortality Rates Overall populationUrban County, 2000-2002 (rounded for ease of computation) ____________________________________________________________

  19. Fetal-Infant Mortality Rates Racial/Ethnic subgroups ofUrban County, 2000-2002 (rounded for ease of computation)

  20. ExcessFetal-Infant Mortality RatesBased on EXTERNAL reference groupRacial/Ethnic subpopulations of Urban County, 2000-2002 (based on rounded rates for ease of computation)

  21. CALCULATING EXCESS NUMBEROF DEATHSFROM Fetal-Infant Mortality Ratesusing External Comparison GroupUrban County, 2000-2002

  22. Urban County by Race2000-2002 Excess Number of Deathsbased on external comparison group

  23. Excess (Internal) Fetal-Infant Mortality Rates Overall populationUrban County, 2000-2002 (note rounding error) ____________________________________________________________

  24. Fetal-Infant Mortality Rates Urban County, by Race, 2000-2002

  25. Urban County by Race2000-2002 Excess Fetal-Infant Mortality Ratesbased on internal comparison group

  26. Urban County by Race 2000-2002 Excess Number of Deathsbased on internal comparison group

  27. PPOR PHASE 2: 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.

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

  29. PPOR Fosters integration with other key efforts • Fetal Infant Mortality Reviews • Previous assessments • Previous perinatal studies or surveillance • PRAMS or other surveys • Health system assessments • Asset mapping • Previous policy and program evaluations “Paint the faces behind the numbers”

  30. PPOR is about impact and results: • Builds data and epi capacity • Promotes effective data use • Strengthens essential partnerships • Fosters integration with other key efforts • Encourages evidence-basedinterventions • Helps leverage resources • Enables systems change for perinatal health

  31. 6 Basic Steps:Perinatal Periods of Risk Approach Step 1: Assure Analytic and Community Readiness Step 2: Conduct Analytic Phases of PPOR Step 3: Develop Strategic Actions for Targeted Prevention Step 4: Strengthen Existing and/or Launch New Prevention Initiatives Step 5: Monitor and Evaluate Approach Step 6: Sustain Stakeholder Investment and Political Will

  32. Headline News… • Stronger local/state partnership builds better • data capacity to address health disparities • Ohio • Successful integration of PPOR, FIMR, Healthy • Start and March of Dimes yields better prevention of feto-infant deaths • Florida

  33. PerinatalPeriodsofRisk: For More Information: www.citymatch.org

  34. By looking at the numbers in a new way, we can finally understand fetal/infant mortality and its common causes. Only through understanding can we take steps to ensure every child gets a chance at life.

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