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The MIME & DIME Projects: Serving high risk mothers of very low birthweight infants

Juanita Graham MSN RN Health Services Chief Nurse MS State Dept of Health. The MIME & DIME Projects: Serving high risk mothers of very low birthweight infants. % of infant deaths by birthweight, MS 2009.

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The MIME & DIME Projects: Serving high risk mothers of very low birthweight infants

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  1. Juanita Graham MSN RN Health Services Chief Nurse MS State Dept of Health The MIME & DIME Projects:Serving high risk mothers of very low birthweight infants

  2. % of infant deaths by birthweight, MS 2009

  3. Retrospective cohort study using linked birth & death certificate files for MS infants, 1996-2003 (n=341,780). A population of (n=297,418) non-Hispanic white & black singleton live-born infants studied Assessing relationship between chronic conditions and IM, LBW, PTB Findings from Linked Data

  4. Findings from Linked Data • Poorest outcomes among: • Black mothers • Black IM rates increased w/ maternal age • < HS education • Single • No prenatal care

  5. Findings from Linked Data • Maternal medical history:

  6. Problem: Many Mississippi babies die very small & very young despite prenatal care Hypothesis: Mississippi women are not healthy enough to achieve a full term, normal weight delivery Solution: Intervention PRIOR to conception Method: IPC for small population with highest risk for poor delivery outcomes What to do? What to do?

  7. Preconception / interconception care pilot programs Rural vs. Urban communities Delta Infant Mortality Elimination Metro Infant Mortality Elimination MIME & DIME

  8. Mississippi State Department of Health – lead agency University of MS Medical Center – principal recruitment site & service provider. Healthy Linkages – referral service for identification of medical homes. Division of Medicaid – data source. Partnering organizations

  9. Federally qualified community health centers – primary care medical homes. World Health Organization Collaborating Center for Reproductive Health – technical assistance. Partnering organizations

  10. Individualized interpregnancy care plan based on assessments of medical/ social risks for subsequent poor pregnancy outcomes Provision of primary health care & dental services in accordance with care plan for 24 months IPC intervention package

  11. Assistance in achieving woman’s desire for subsequent pregnancies & need for optimum child spacing (ideally 18-20 months); Provision of appropriate social services & community outreach in each woman’s community. IPC intervention package

  12. Expansive, rural geographical area Transportation Limited resources Limited funding Problems & lessons learned

  13. On-going surveillance combined with comprehensive evaluation at the project’s end Health, reproductive and economic outcomes to be evaluated Cost-benefit analysis to compare cost savings to costs of program Project evaluation

  14. Goal: Funding to support statewide expansion of program Format: Medicaid waiver; other internal options include focusing on increased enrollment and participation in reimbursable programs that could sustain the program Goal

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