Declining Infant Mortality Rates in Maryland: The Babies Born Healthy Initiative
By Bonnie S. Birkel, CRNP, BSN, MPH
Director, Maryland Center for Maternal and Child Health
As is the case in many states, racial and ethnic disparities exist for 10 of the 14 leading causes of death in Maryland. It is no surprise that infant mortality is among these. In recognition, Gov. O’Malley has made reducing infant mortality (and the racial disparity in infant mortality) one of the 15 strategic goals tracked by the Governor’s Delivery Unit (GDU). Fortunately, Maryland experienced a 10 percent decrease in infant mortality rates from 2008 to 2009 and a 7 percent decrease from 2009 to 2010, reducing rates to 6.7 per 1,000 live births (click here for the full report). This success is due in part to efforts spearheaded by the Maryland Center for Maternal and Child Health (CMCH) with many public and private sector partners at the state and local level.
Babies Born Healthy (BBH) is a collaborative, interagency program focused on three primary strategies for improving birth outcomes – healthier women prior to and between pregnancies (i.e. interconception); early enrollment in prenatal care; and post-delivery follow-up for high-risk infants and mothers. Efforts have been targeted to jurisdictions where infant mortality and racial disparities in pregnancy outcomes are highest – Baltimore City, Prince George’s County and Somerset County (Dorchester County was added in April 2011).
A new comprehensive women’s health model has expanded family planning services to include risk assessment and screening for chronic diseases. Through close partnership with Medicaid, a new Accelerated Certification of Eligibility (ACE) process assures Medicaid-eligible women that they will have access to prenatal care as early as possible and a Quickstart prenatal care visit is offered at health departments in the target jurisdictions. To ensure that high-risk babies and mothers receive post-partum follow-up, a statewide standardized post-partum discharge referral process is being developed and a post-partum Infant and Maternal Referral Form has already been implemented statewide (more information available here).
Promoting safe sleep has also been an integral component of the program. A safe sleep video developed by the B’More for Healthy Babies program in Baltimore City has been distributed widely around the state (video available here). Key partners in all of these efforts have been the Department of Health and Mental Hygiene Office of Minority Health and Health Disparities, the Governor’s Office on Children, the Maryland Department of Human Resources, the Community Health Resources Commission, the Maryland Patient Safety Center and Carefirst.
For more information on Babies Born Healthy, please contact Maura Dwyer, DrPH, Health Policy Analyst, Maryland Center for Maternal and Child Health, at (410) 767-3702 or firstname.lastname@example.org.
The MIME and DIME Programs: Challenges and Successes of Implementing Interpregnancy Care among High-Risk Mississippi Women
By Juanita Graham, MSN RN
Connie Bish, PhD
Lei Zhang, PhD
Danielle Seale, LCSW
Mississippi State Department of Health
Mississippi has the highest state rate of infant mortality in the United States. Over the past several years, new studies and programs have been implemented to address maternal and infant health. Modeling a program implemented in Georgia, the Mississippi State Department of Health (MSDH) implemented pilot programs in two communities among women who delivered a very low birth weight infant. Very low birth weight accounts for more than half of Mississippi infant deaths each year. The pilot communities are predominantly African American with high rates of poverty, low birth weight (LBW) deliveries, infant mortality and morbidity combined with low rates of health insurance coverage and access to primary care services. The Metropolitan Infant Mortality Elimination (MIME) and Delta Infant Mortality Elimination (DIME) programs give varying perspectives – urban and rural – of implementing interpregnancy care in Mississippi.
The MIME and DIME projects have three aims for program participants: (1) Improve overall health status and optimize child spacing; (2) Reduce subsequent poor pregnancy outcomes; and (3) Share program findings with maternal and child health stakeholders. The projects are highly collaborative, incorporating partnerships and contractual agreements between state, private and community-based resources.
Since recruitment began in February 2009, 110 women have enrolled in the projects. Case studies of success stories and challenges are being documented. A large staff dispersed across a large geographic area in DIME provided unique challenges in case management that the urban MIME program did not experience. Extensive evaluation activities are being implemented to assess both health and financial outcomes. Early data suggest improved outcomes and achievement of adequate child spacing. With these successes in mind, the MSDH is implementing expanded access to basic components of the program. The vision for these programs is to provide more women with the knowledge and services needed to be proactive in reproductive health decisions and preconception health.
Generally speaking, healthier mothers have healthier babies. Thus, improving the health of mothers prior to pregnancy could improve outcomes for Mississippi infants and their families. If proven effective, MSDH plans to expand the MIME and DIME programs to other areas of the state upon availability of adequate funding. For more information, contact Juanita Graham, DNPc, MSN, RN, Health Services Chief Nurse, Mississippi State Department of Health at email@example.com.
HRSA/MCHB’s Division of Healthy Start and Perinatal Services Interconception Care Learning Collaborative (ICC-LC)
By Stacey D. Cunningham, MSW, MPH
Executive Director, National Healthy Start Association
In 2008, the Division of Healthy Start and Perinatal Services (DHSPS) in the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) launched one of the largest action learning collaboratives, with over 500 individuals representing the federal Healthy Start Initiative. The ICC LC strives to improve the health and well-being of women and infants served by all 104 Healthy Start grants by advancing the quality and effectiveness of women’s health during interconception care in each project. The overarching goal is to apply a quality improvement "learning collaborative" model to improve non-clinical, community-based services in all Healthy Start communities across the country. DHSPS focused on interconception care and the outcomes show how ICC research can be translated into practice. Currently, the projects are completing the third cycle of the collaborative.
The ICC LC uses the Plan-Do-Study-Act (PDSA) model developed by the Institute for Healthcare Improvement to integrate evidence-based practice and innovative community-driven interventions to improve care in specific topic areas. Healthy Start grantees were placed in collaborative groups based on their choice of five core content areas from which they chose in each of the three cycles. These areas included case management; family panning/reproductive health; healthy weight; ICC risk screening/assessment; maternal depression; and primary care linkages. Within each core content area, each collaborative selects one of the three change concepts to work on within their individual project area. The three change areas are strengthening partnerships and linkages among community providers; advancing use of evidence-based tools, data collection and performance monitoring; and improving staff training and protocols to improve quality and consistency. A total of 16 collaboratives were formed with the 104 projects.
Each cycle helped grantees move forward in the collaborative process. Cycle I focused on training grantees on the PDSA process; Cycle II focused on creating and implementing measures; and Cycle III currently uses the continued and improved reporting of measures by each collaborative. Each of the 16 collaboratives chose common measures as a small group in Cycle II. The data collected from each collaborative demonstrated improvement and include examples, such as 31 linkages/partnerships were established, reestablished or strengthened; 111 women were screened using selected tools; and 87 Healthy Start community staff were trained on the updated or established protocols.
For more information on the Interconception Care Learning Collaborative, contact DHSPS at (301) 443-0543.