P erinatal P eriods o f R isk

1. A CityMatCH “How-to-Do” Workshop Perinatal Periods of Risk Analytic Readiness Bill Sappenfield

2. “If you don’t know where you are going, there are many ways to get there…” Old African Proverb

3. PPOR Conceptual Framework

4. Improve Maternal & Infant HealthSeeing the “Big Picture”

5. Seeing the “Big” Picture Planning Cycle Assessment Perinatal Periods of Risk

6. Big PicturePlanning Cycle • Community readiness and investment • Stakeholders • Vision • Planning process • Resources available or planned • Timeframe • Accountability

7. Community Assessment • Previous assessments • Previous perinatal studies or surveillance • Fetal and infant mortality reviews • PRAMS or other surveys • Health system assessments • Asset mapping • Previous policy and program evaluations • Decision-making process

8. Analytic Readiness:What Does it Mean?

9. PPOR Analytic Readiness: What does it means? • Data access/quality • Minimum number of events • Adequately trained analytic staff • Adequately trained communication staff • Analysis team including program staff • Sufficient staff hours • Strong leadership agreement & support

10. Direct Data Access/Quality? • 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 • Gestational age • Birthweight • Education • Race/Ethnicity

11. PPOR Minimum? Overall, and every subpopulation or geographic region needs roughly 60 feto-infant deaths to have sufficient numbers to calculate rates.

12. Adequately Trained Analytic Staff? • Analyze large data files • Familiarity with birth and death files • Assess data quality and reporting • Calculate and compare rates • Estimate confidence limits and p-values • Investigate causes and risk factors • Conduct multivariate analysis • Summarize analytic findings • Understand perinatal health issues

13. Adequately Trained Communication Staff? • Determine Single Overriding Communication Objective • Develop compelling messages • Condense numbers and figures • Write reports and fact sheets • Produce graphic presentations • Tailor communications to the audience

14. Analysis Team? • Data analyst • Policymaker or staff • Program or content specialist • Clinical specialist • Vital records specialist • Communication expertise

15. Sufficient Staff Hours for Both Phases? • Preparation • Phase 1 analysis • Phase 2 analyses • Communication preparation • Participation in dissemination and follow up

16. Strong Leadership Agreement & Support? • 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

17. PPOR Analytic Readiness: What does it mean? • Data access/quality • Minimum number of events • Adequately trained analytic staff • Adequately trained communication staff • Analysis team including program staff • Sufficient staff hours • Strong leadership agreement & support

18. PPOR Analytic Readiness: What does it mean?  • Data access/quality • Minimum number of events • Adequately trained analytic staff • Adequately trained communication staff • Analysis team including program staff • Sufficient staff hours • Strong leadership agreement & support      

19. Ready, Aim, and Fire!