National Infant Mortality Collaborative Innovation and Improvement Network (CoIIN)

Transcription

1 National Infant Mortality Collaborative Innovation and Improvement Network (CoIIN) Title X Grantee Meeting August 19, 2015 Sabrina Selk, ScD Senior Analyst Department of Applied Research and Evaluation National Institute for Children s Health Quality (NICHQ) 1

2 Background Spring 2010: SHOs in South commit to regional effort to reduce infant mortality and prematurity Dec. 2010: Letter to Secretary Sebelius, meeting with HRSA Administrator Wakefield Oct. 2011: David Lakey, MD (TX State Health Commissioner) issues ASTHO s Healthy Babies President s Challenge Jan. 2012: HRSA Summit for Regions IV, VI July 2012: HRSA Regions IV/VI Collaborative Improvement & Innovation Network (CoIIN) Mar. 2013: HRSA IM Summit & and CoIIN Launch for Region V Oct. 2013: Region IV, V, and VI hold joint CoIIN Meeting July/Aug. 2014: National Roll Out of CoIIN Regions I-III, VII-X, and Pacific Islands to hold Infant Mortality Summits & launch CoIIN Feb 2015: States choose strategies, and hold first national learning sessions for each learning network, enter into first Action Period July 2015: Second learning session of National IM CoIIN held to celebrate and learn from early wins 2

3 Strategies to Address Infant Mortality With a set of committed partners we are helping states work on the following priority areas: Improve Safe Sleep Practices (n=37) Reduce smoking before, during and/or after pregnancy (n=21) Reducing EED and increasing progestogen use (n=21) Increase Risk Appropriate Care to ensure the delivery of higher-risk infants and mothers at appropriate level facilities (n=13) Address Social Determinants of Health by incorporating evidence-based policies/programs & place-based strategies to improve equity in birth outcomes (n=23) Promote optimal women s health before, after and in between pregnancies during Postpartum Visits & Adolescent Well Visits with Pre & Interconception Care (n=29) 3

4 Target Outcomes for IM CoIIN Decrease Infant Mortality Decrease Neonatal Mortality Decrease Post-neonatal Mortality Decrease Preterm-related Mortality Decrease SUID Mortality Decrease Preterm Births 4

5 Preconception/Interconception Health n=29 LEGEND Learning = Network Chosen Puerto Rico

6 Aim Statement By July 2016, we will improve life course care for women related to pre and inter conception care. Our goals are to: 1. Improve the postpartum visit rate 10% or more relative to the State baseline 2. Improve adolescent well visit rate 10% or more relative to the State baseline 3. Improve birth intention and client choice of contraceptive methods including most and moderately effective contraception 4. Improve birth spacing and reduce the proportion of live births that were conceived <6 and <12 months from the previous live birth by 10% or more relative to State baseline and ultimately <18 5. Reduce racial/ethnic disparities, improve health equity in the above goals relative to non-hispanic Whites by 10% or more relative to the State baseline States may customize the goals based on their area(s) of focus 6

7 Pre and Interconception Care Driver Diagram 7

8 Comprehensive Health Care in Childbearing Years Two examples using Primary Driver of Comprehensive Health Care and Secondary Driver of Reproductive Life Course Planning. State Example 1: Developed culturally diverse brochure on importance of birth spacing and contraceptive methods for pubic health providers. State Example 2: Use One Key Question to promote tools available on preconception health and birth control counseling. Primary Driver Ensure access to a medical home. Secondary Drivers Comprehensive Health Care in Childbearing Years Focus on prevention. Focus on reproductive life course planning. Focus on chronic conditions. Increase provider competency around moderately and most effective contraception and develop simple stocking options 8

9 Comprehensive Health Care in Childbearing Years, Cont. Another state example, same primary driver, now Secondary Driver is Focus on Prevention. State Example 3: Title V Adolescent program has ongoing MOA with tribal and non tribal CHC with high rates of repeat teen births and single women and funds are provided to purchase LARCs for low income women Secondary Driver Change Ideas Include boys and adolescent males in pregnancy prevention, and life course planning education. Offer services outside of school based clinics for those who are not in school or do not have access to school based clinics. Focus on prevention Identify and help modify biomedical, behavioral, and social risks to a woman s health or pregnancy outcomes. Offer training to providers on how to do thorough risk assessments. Promote and support regular use of multivitamin with folic acid for all women of reproductive age. 9

10 Comprehensive Health Care in Childbearing Years, Cont. More state examples, same primary driver, now Secondary Driver is Increasing Provider Competency Around Moderately and Most Effective Contraception. State Example 4: Improved % of female family planning clients who left a family planning visit with an effective or highly effective contraceptive method. State Example 5: Change reimbursement policy to cover cost of LARC inserted in hospital prior to discharge. State Example 6: LARC immediate postpartum insertion CME module developed and launched. Secondary Driver Change Ideas Increase provider competency around moderately and most effective contraception and develop simple stocking options Offer training opportunities for providers around long acting, reversible contraception. Offer training on how to support women making most informed and best choice of contraception. Help providers, clinics, hospitals develop just in time purchasing, pay-as-dispensed systems and inventory/vendor management for most effective, reversible contraception. 10

11 State Outcome Measures OUTCOME MEASURES Percentage women using moderately effective and most effective contraception during childbearing years Percentage women using most effective, reversible contraception during childbearing years Birth spacing Postpartum visits Adolescent well visits

12 Pilot Site Measures OUTCOME MEASURES Percentage women using moderately effective and most effective contraception during childbearing years Percentage women using most effective, reversible contraception during childbearing years Birth spacing Postpartum visits Adolescent well visits PROCESS MEASURES Woman well visit content bundle

13 Where do Title X clinics fit in? Title X clinics are acting as pilot sites for the testing of change ideas related to the pre/interconception care learning network. This is where the important work of learning occurs as pilot sites implement evidence-based approaches and learn from the work happening across other sites across the country. Then these results are shared with other states to help spread and sustain these best practices to other programs trying to help women and children achieve the highest standard of health. We welcome you to consider how you can be involved in this important initiative! 13

14 For more information visit our website: nichq.org/coiin or us at