secretary’s advisory committee on infant mortality november 14, 2012 david lakey, m.d....
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Secretary’s Advisory Committee on Infant Mortality
November 14, 2012
David Lakey, M.D.Commissioner
Texas Department of State Health Services
Maternal Care
Newborn Care
Infant Health
Maternal Health/
Prematurity
Preconception Health Health Behaviors
Perinatal Care
Prenatal Care High Risk Referral
Obstetric Care
Perinatal Management Neonatal Care
Pediatric Surgery
Safe Sleep Breast Feeding Injury Prevention
2
Possible Points for Intervention
29
9
23
15
41
23
0
10
20
30
40
50
Wei
gh
ted
%
White Black Hispanic
19902010
Adult Obesity in Texas(1990 vs. 2010)
3
Texas Women Fail to Meet Healthy People 2020 Prenatal Care Goal
2005 2006 2007 2008 2009 20100.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
64.0 61.5
59.6 59.1 59.1 64.7
Percent of Mothers Who Received Prenatal Care in the First TrimesterTexas 2005-2010
TX Healthy People 2020 Goal (77.9%)
Year
Per
cen
t o
f L
ive
Bir
ths
4
Almost Half of Black Women in Texas –No First Trimester Prenatal Care
All Race/Ethnicities White Black Hispanic Other0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
64.7
72.7
54.160.9
68.8
Percent of Mothers Who Received Prenatal Care in the First Trimester of Pregnancy by Race/Ethnicity, Texas 2010
Received PNC in 1st Trimester Healthy People 2020 Goal (77.9%)
Race/Ethnicity
Per
cen
t o
f L
ive
Bir
ths
5
Inductions Have Increased Steadily in Texas and the US
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20104.0
9.0
14.0
19.0
24.0
29.0
18.4
25.8
19.9
23.4999999999999
Induction Births, Texas and U.S., 2000-2010
TX United StatesYear
Per
cen
t o
f L
ive
Bir
ths
6
Elective Inductions Increase Prematurity and C-Section Rates
• In 2010, 1 in 4 deliveries were induced in Texas
• Induction rates increased by 40% in Texas between 2000-2010
• In 2010, 38.4% of single-birth inductions were performed before 39 weeks of gestation
• Labor induction is associated with an increased risk of delivery by cesarean section (C-section) 7
Preventing Infant Mortality through Regionalization of Perinatal Services
• Very low birth weight (VLBW) infants – Represent less than 2% of US births– Account for 55% of infant deaths
• Levels of perinatal care (I, II, & III)– Level III facilities have the ability to care for very low birth
weight infants.– VLBW infants not born in a level III hospital are more likely
to die.
• HP 2010 goal: 90% of all VLBW infants are born in level III hospitals– Only met by 5 states– 10 states (including TX) are below 70%
8
Healthy Texas Babies
• Healthy Texas Babies (HTB) is an initiative to decrease infant mortality in Texas
• Goals of Healthy Texas Babies Initiative:
– Provide local partnerships and coalitions with major roles in shaping programs in their communities
– Use evidence-based interventions– Decrease preterm birth rate by 8% over 2 years– Save ~ $7.2 million in Medicaid costs over 2 years
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• Legislation to eliminate Medicaid payment for elective inductions/C-sections <39 weeks
• Outreach campaign to promote father’s involvement with children before birth
• Council created to study neonatal intensive care unit regionalization
• $4.1 million General Revenue appropriated for this effort
Healthy Texas Babies
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HTB Local Coalitions
Eleven Local Coalitions Evidence-based
projects Broad-based
Membership December 2011-
August 2013 $200K contracts
awarded to each of the 11 local coalitions
11
DSHS Local Coalition Initiatives
• Corpus Christi – Preconception Diabetes Management
• Dallas – Feto-Infant Mortality Review Board
• El Paso – Enhanced identification of high-risk pregnancies
• Fort Worth – Fatherhood Mentoring for Teen Dads
• Galveston – Mother-Friendly Worksite – Breastfeeding
• Houston – Pre- and Inter-conception Wellness
• Laredo – Media Campaign on Perinatal Health
• Longview – Centering Pregnancy ®
• Lubbock – Stork’s Nest®
• San Antonio – HOPES Project: Case Management for Mothers with Previous Poor Birth Outcomes
• Waco – Healthy Babies are Worth the Wait®
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“Someday Starts Now”
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“Someday Starts Now”
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“Protect Two From the Flu”
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16
17
2009 2010 2011 2012
Year
Texas Pre-Term Birth Rates
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
White 11.5 11.8 12.1 12.7 12.8 12.9 12.5 12.5 12.2 11.8 11.8 11.1776262567896
11.0754174799393
Black 17.3 18 18 19 18.5 18.8 18.5 18.2 17.4 17.6 17.7 16.746604615
823
16.399834093
737
Hispanic 12.3 12.6 13.1 13.5 13.2 13.3 13.4 13.5 13.2 13 13.3 13.2450404954209
12.7529055078322
Other 11.7 11.4 11.3 11.7 11.2 11.6 11.7 11.5 11.2 11.4 12 11.4193346542914
10.949410949
411
Texas 12.6 12.9 13.2 13.7 13.6 13.7 13.6 13.6 13.2 13 13.3 12.8242985003725
12.4810442460889
1.03.05.07.09.0
11.013.015.017.019.0
White Black Hispanic Other Texas
Preliminary & Par-tial Year Data
18
ASTHO Presidents Challenge 2012: Healthy Babies
Goal: Improve birth outcomes by reducing infant mortality and prematurity in the United States.
Overall Objectives:
1. Focus on improving birth outcomes as SHOs and state leadership teams work with state partners on health and community system changes.
2. Create a unified message that builds on the best practices from around the nation and the efforts from Regions IV and VI, which can be adopted by states, U.S. territories, and the District of Columbia.
3. Develop clear measurements to evaluate targeted outreach, progress, and return on investment.
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ASTHO President’s ChallengePledge to Reduce Prematurity by 8% by 2014
20
State Strategies to Improve Birth Outcomes
• Reduce early elective deliveries <39 weeks
• Access topreconception/interconception care
• Smoking cessation• Preventing SIDS• Improve perinatal
regionalization• Expand access to 17-P
Reduce Elective Deliveries <39 Weeks
• Louisiana – Louisiana Birth Outcomes Initiative
• Texas – House Bill 1983
• West Virginia – Universal Maternal Risk Screening Program
• Indiana – 40 Weeks of Pregnancy, Every Week Counts Provider Toolkit
• Kentucky- Healthy Babies are Worth the Wait
Oklahoma - Every Week Counts
• Began recruiting hospitals for voluntary “hard stop” effort in January 2011
• Currently have 52 of 59 birthing hospitals enrolled (88%)
• Have seen 70% reduction in rate of induction <39 weeks without medical indication
24%
70%
7.2%
• Georgia – expanded Section 1115 Medicaid waiver
• Oregon – Innovative Reproductive Health Program combines Title X and Medicaid family planning waiver programs
• South Carolina – Campaign to Prevent Teen Pregnancy website
• California – The Interconception Care Project
Access to Preconception, Interconception Care
• Colorado – Colorado QuitLine, a free program for pregnant women
• Oklahoma – practice facilitation model in obstetric care settings; SoonerQuit statewide media campaign
• North Carolina – You Quit Two Quit Project
• Massachusetts – QuitWorks referral program
• Michigan – free quitline counseling for uninsured or Medicaid enrollees
Smoking Cessation
• Georgia – Crib Matching Program through SIDS Injury Prevention Program
• Maryland – B’more Babies Safe Sleep Campaign
Preventing SIDS
• New York – Regional Perinatal Center (RPC) leads and coordinates affiliated hospitals
• Tennessee – Perinatal Advisory Committee; five statewide centers provide 24-hour consultation and referral
Improve Perinatal Regionalization
• North Carolina – 17-P is part of the Pregnancy Medical Home program
• Louisiana – 17-P Louisiana Resource Center
Expand Access to 17-Hydroxyprogesterone (17-P)
Thank You!
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