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How Healthy are our Babies ?

How Healthy are our Babies ?. Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009. Susan E. Wilson, BGS Healthy Babies Program Director Ty Kane, MPH Community Health Analyst & IMR Coordinator. Healthy Babies Goal.

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How Healthy are our Babies ?

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  1. How Healthyare our Babies? Kansas Blue Ribbon Panel on Infant Mortality August 28, 2009 Susan E. Wilson, BGS Healthy Babies Program Director Ty Kane, MPH Community Health Analyst & IMR Coordinator

  2. Healthy Babies Goal Improve birth outcomes among at-risk moms by reducing the incidence of premature and low birth weight births and infant deaths.

  3. Healthy Babies Program • Group Education • In-office Visits • Home Visits

  4. Education and Referral • Nutrition/Healthy Weight • Labor & Delivery • Basic Baby Care • Breastfeeding • Infant Growth and Development • Parenting Skills • Relationships • Birth Spacing • Sexually Transmitted Diseases • Self-Esteem and Goal-Setting • Education, Employment and Budgeting

  5. Screening, Education & Referral • Smoking • Depression • Domestic Violence • Drug and Alcohol Use • Lead Poisoning • Infant Development

  6. Healthy Babies Services (2008) • 716 Incoming Referrals • 8,500 Group, Homeand Office Encounters • 1,021 Moms & Babies

  7. Healthy Babies Program Priorities(based on Healthy People 2010 objectives) • Decrease the Infant Mortality Rate • Decrease the Premature Birth Rate • Reduce the Low Birth Weight (LBW) Rate • Increase Prenatal Care Entry • Increase Breastfeeding Rates (info from www.modimes.org)

  8. Healthy Babies Funding • Annual budget ($1.78 million) • Additional one-time monies SFY2010 ($569K) • 88% grant funded • 31% of total funding is federal Healthy Start

  9. Healthy Start - NEWHSI • Northeast Wichita Healthy Start Initiative – referred to as NEWHSI • Funded since 1997 • Targeted zip codes (67208, 67214, 67219) • Poor African American birth outcomes • Applications in 2007 and 2008 to extend targeted zips to 67203, 67210, 67213 and 67218 were approved by HRSA but unfunded due to budget constraints

  10. NEWHSI Infant Mortality (2005-2007 three year averages) • All races (all zips) 16.72 deaths/1,000 • African American (all zips) 26.50 deaths/1,000 • Up from 16.49 for the three years ending 2000 • All races (67214) 21.07 deaths/1,000 • African American (67214) 26.12 deaths/1,000 • Up from 21.67 for the three years ending 2000 Data provided by KDHE

  11. Healthy Babies Infant Mortality • 0.00 infant deaths reported (2002-2007) • For clients residing in one of the three NEWHSI zip codes and enrolled in the Healthy Babies program • Two infant deaths reported (grant year 2008) • For all clients enrolled in the Healthy Babies program, all zip codes • Both unpreventable due to congenital anomalies Data provided by KDHE

  12. NEWHSI Infant Mortality Rates (3-year average) Data provided by KDHE Bureau of Health Informatics

  13. What are we going to do? • Social marketing campaign targeting preconception care • Use Community Navigators to provide peer education among at-risk populations and increase referrals • Provide reproductive health education to middle and high school students in the Wichita Public Schools • Implement new software to increase ability to analyze and share birth outcome data with KDHE and local evaluator • Extend the Infant Mortality Review (IMR) Project to help determine the social factors associated with infant deaths in Sedgwick County

  14. Sedgwick Co IMR Project Timeline • Fall 2004 – Began dialogue with KDHE regarding data needs as related to the NEWHSI grant • Fall 2004 thru Fall 2007 • Purchased zip-code specific data from KDHE • Nurtured partnership with KDHE Bureau of Health Informatics and the Kansas City Healthy Start (KCHS) Project via phone and in-person meetings to discuss grant objectives, program outcomes and target area stats • Fall 2007 – Partner with KCHS to fund KDHE research agreement to gain “greater understanding of the social and health issues related to pregnancy outcomes and infant mortality…” • Fall 2008 thru Spring 2009 – Chart Abstractions • June 2009 - Convene Case Review Team (CRT) • February 2010 – Begin abstraction of 2010 charts

  15. Sedgwick County IMRProject Partners • Sedgwick County Health Department • Kansas City Healthy Start • Kansas Department of Health and Environment • Bureau of Health Informatics • Bureau of Local and Rural Health • Central Plains Regional Health Care Foundation • Medical Society of Sedgwick County • KUMC– Wichita, Office of Research • SIDS Network of Kansas

  16. SCHD/KDHE Agreement • Created as part of an on-going KDHE QA/QI project • Bureau of PHI authority allows abstraction of maternal and infant death records: • To verify hospital compliance with completing birth and infant death certificates • To collect data specific to infant deaths and stillbirths (No patient contact; Work by KDHE staff) • To allow comparison of birth outcome data between individuals served/not served by Healthy Babies (All work done in non-identifying manner) • KS Statute puts restrictions on a maternal interview

  17. Importance of the Maternal Interview • To facilitate the bereavement process and provide appropriate referrals. • To learn about the mother’s experiences before and during pregnancy. • To learn about events during the infant’s life and around the time of death. • To identify community assets and deficits that affected the mother’s life during the pregnancy, birth and death of her infant. • To accurately summarize and convey the mother’s story of her encounters with local service systems and her loss to the community thru the FIMR case review. • To assess the family’s needs and provide culturally appropriate health and human service referrals as needed.

  18. Preliminary Results from 2005 Abstractions • 95 Charts abstracted at Via Christi and Wesley • 63 infant deaths • 32 stillbirths • Non-Hispanic (82.1%) • Black (22.1%) • White (53.7%) • Other (6.3%) • Identified Payer Source (51.6%) • MCD (49.5%) • Private Insurance (2.1%) • Self-pay (36.8%) Data provided by KDHE

  19. Preliminary Results from 2005 Abstractions • Singleton Births (88.4%) • Prematurity (71.6%) • Very Preterm/<32 weeks (50.5%) • Moderate Preterm/32-33 weeks (11.6%) • Mother’s age <30 (72.7%) • <20 yrs. (24.2%) • 20-24 yrs. (18.2%) • 25-29 yrs. (30.3%) • Pre-pregnancy abnormal BMI (84.4%) • Underweight (14.7%) • Overweight (15.2%) • Obese (27.3%) Data provided by KDHE

  20. What next? • Enter into new agreement with KDHE to begin 2010 case abstractions. • Hire abstracter and hold “real-time” case reviews. • Further develop Community Action Team (CAT). • Use 2005 case review data as baseline to compare to 2010 data. • Sedgwick County • NEWHSI residents • NEWHSI residents served by Healthy Babies Program

  21. Sedgwick County Contacts Susan E. Wilson, BGS Program Director Healthy Babies Sedgwick County Health Department 434 N. Oliver, Suite 110 Wichita, KS 67208 316-660-7386 sewilson@sedgwick.gov Ty Kane, MPH Community Health Analyst & IMR Coordinator Sedgwick County Health Department 1530 S. Oliver, Suite 270 Wichita, KS 67218 316-660-7368 tkane@sedgwick.gov

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