first year cleveland - better health...
TRANSCRIPT
First Year Cleveland
Thursday, September 15, 2017
Presenters
Jennifer Bailit, MD, MPH, Physician Executive Practice Management and Provider
Integration. Service Line Medical Administrator Women and Children’s Health
and Wellness for The MetroHealth System
Bernadette Kerrigan, Executive Director, First Year Cleveland, CWRU School of
Medicine
2
No financial or non financial
conflicts of interests relevant to
this presentation
3
Three Objectives for today’s presentation
1. Create a common understanding of Infant Mortality and 3 year plan
2. Understand reasoning for coordinating and aligning medical, non profit, faith
based and academia around three priority areas
• Reduce Racial Disparities
• Address Extreme Prematurity- 22 weeks gestation or less
• Eliminate sleep related death
3. Secure your support in building public will, advancing public policy and obtain
sustainable funding on what works
UNDERSTANDING THE PROBLEM
Situation
• Cuyahoga County – One of highest infant mortality rates in the US, large disparities
between black and white babies
• In 2015: Leading causes: extreme prematurity ( fetus born before 22 weeks)
• and preventable sleep-related deaths
Infant mortality rates in the City of Cleveland and Cuyahoga County
– Persistent for 40+ years 5
• From 2013-2014 only infants of non-Hispanic white women
had a decline in IMR (3%).
• From 2005-2014 the rate declined:
o 21% for Asian and Pacific Islander women,
o 20% for infants of non-Hispanic black women,
o 15% for infants of non-Hispanic white women.
• From 2005-2014 infants of both non-Hispanic black and
American Indian or Alaska Native women had the highest
IMRs .
7
0
2
4
6
8
10
12
14 OHIO Total IMR: 1980-201512.8
7.2
44% IMPROVEMENT!
SOURCE: ODH
0
5
10
15
20
25
White Black
Ohio White & Black IMR: 1980-2015
Source: ODH
1.95
2.75
31% Improvement
51% Improvement
0
5
10
15
20
25
White Black
Ohio White & Black IMR: 1980-2015…Survival Time LAG
We have to go as far back as 1975 to find a White IMR comparable to our 2015 Black IMR. This
suggest a 40-year survival time lag, meaning that unless we change this pattern, Black babies in Ohio
have to wait until the year 2055 to experience the same opportunity to survive the first year of life
as White babies did in 2015. We think this is unfair, unjust and we know that we can do better.
Source: ODH
15.05
11.2
0
5
10
15
20
25
White Black
Ohio White & Black IMR: 1980-2015
Source: ODH
ab
8.2
Healthy People 1990
a = HP-1990 Overall IMR Goal of 9
b = HP-1990 Black IMR Goal of 12
Ohio achieved/exceeded the HP-Overall IMR Goal of “9” for White babies in 1987, 3-years
in advance of the goal date
0
5
10
15
20
25
White Black
Ohio White & Black IMR: 1980-2015
Source: ODH
e = HP-2010 Goal IMR Goal of 4.5
Ohio, like most States, did not achieve the HP-2010 Goal
Healthy People 2010
e
0
5
10
15
20
25
White Black
Ohio White & Black IMR: 1980-2015
Source: ODH
f = HP-2020 IMR Goal of 6
Ohio achieved this goal for White babies in 2013, 7-years in advance of the goal date.
So, Ohio has achieved HP IMR goals for White babies in advance of the goal dates for
3 of the 4 Healthy People periods.
Healthy People 2020
f
OHIO 2015 WHITE AND BLACK IMR:
0
2
4
6
8
10
12
14
16
15.1
BlackWhite
5.5
15
16
26 OUT OF OF 27 SLEEP RELATED DEATHS WERE PREVENTABLE
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2015 CUYAHOGA COUNTY IM RATE 10.4%
155 INFANT DEATHS FROM 14,844 BIRTHS
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Accident Homicide Infections
& other Medical
Complications
Birth
Defects
Sleep
Related
Prematurity
1 4 15 21 27 87
RESPONSE TO THE PROBLEM
Response: Create First Year Cleveland
Vision: Every baby born in Cuyahoga County will celebrate a first birthday
Mission: First Year Cleveland’s mission is to mobilize the community through partnerships and a unified strategy to reduce infant deaths including racial disparities
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First Year Cleveland fulfills its vision and mission
by creating a common understanding of the problem and leading the
development and coordination strategies to solve it.
A HA MOME NTS A F TE R A RECORD RE VIE W ON 8 7 PRE MATURE DEATHS
6 0 OF THE DEATHS WE RE A F RICA N A ME RICAN BA BIES
�This is not a teen pregnancy, drug and alcohol usage, no prenatal care problem� In fact, Cuyahoga County has the best prenatal care rate in Ohio 78.8 %
� Over 80 % of all 2015 premature deaths, 70, were non-viable fetuses born between 15 weeks and 22 weeks gestation; with 40% of these moms having a loss within 12 months prior.
�This means after 23 weeks gestational birth , only 17 babies died within our 14,844 births - remarkable 1.14 IM Rate
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21
MEIS RCT
Meis NEJM 2003
AUDIT AND FEEDBACK
• Information is gathered about a physicians behavior/practices. This is
returned and compared to how others are doing.
• Underpinning of OPQC
HOW DOES OPQC WORK?
• Hospitals invited to join
• Data collection sheet designed
See OPQC.net for forms
• Entered into a data agreement/IRB approval
• Hospitals collected de identified data and sent it in to OPQC
• OPQC sends back benchmarking charts
• Phone calls
• Birth certificate data
• Role of FYC
• To ensure our community has a collective understanding of why our babies are dying,
• To align and coordinate systems and programs around a shared vision and plan that is
aligned to data,
• To address data gaps,
• To advance and improve public policies aligned with FYC work,
• To mobilize funding, and
• To build and sustain public will.
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Dr.
Dept.
Hospital
Community
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• First Year Cleveland was founded on 12.30.15 by thirteen community leaders to reduce high infant deaths in Cuyahoga County, particularly among African American babies.
• Thanks to the Generosity of the Cuyahoga County Executive Office, County Council, Mayor’s Office and City Council, $2 Million was invested as start up funding.
• In a competitive process CWRU School of Medicine was selected as fiscal agent and is over over $500,000 in-kind over a three year period.
• $4.9 Million ODM grants were secured and awarded to 10 local programs to imprpve maternal and birth health outcomes. Areas of focus for expansion included centering pregnancy, home visitors programs, fatherhood program and faith based safe sleep initiative.
• Bernadette Kerrigan was hired as Inaugural Executive Director
FINDING THE RIGHT CHAMPANIONS TO LEAD THE THE INAGURAL STRATEGIC PLAN WAS KEY--
Akram Boutros, MD, FACHE
(Co-Chair)
President and Chief Executive Officer The MetroHealth System
Patti DePompei
(Co-Chair)
President University Hospitals, Rainbow Babies & Children's Hospital, MacDonald
Women's Hospital
Terry Allan Commissioner Cuyahoga County Board of Health
Jennifer Bailit, MD Physician Executive, Practice Management and Provider
Integration, Women and Children’s Health & Wellness
The MetroHealth System
Mitchell Balk President The Mt. Sinai Care Foundation
Armond Budish Cuyahoga County Executive Office of the County Executive
John Carl, MD Center Head, Center for Pediatric Pulmonary Medicine Cleveland Clinic
Matt Carroll Chief Economic Growth and Opportunity Officer Office of the Cuyahoga County Executive
Marcia Egbert Senior Program Officer Gund Foundation
Christin Farmer Executive Director Birthing Beautiful Communities
Tim Jarm Chief Executive Officer and President The Center for Health Affairs
Kevin Kelley President Cleveland City Council
Michael Konstan, MD Vice Dean for Translational Research Case Western Reserve University School of Medicine
Stanley Miller Pastor Rust, United Church of Christ
Natoya Walker-Minor Chief of Public Affairs The City of Cleveland
Staff:
Bernadette Kerrigan Executive Director First Year Cleveland
Elizabeth "Bede" Littman Senior Director, Government Relations Strategic Initiatives Case Western Reserve University School of Medicine
Consultants: Robert Eckardt, DrPH
Jennifer Madden, PhD
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INCLUSIVE AND A DATA DRIVEN PROCESS WAS KEY TO FYC STRATEGIC PLAN
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Academy of Medicine of Cleveland &
Northern Ohio (AMCNO)
Cuyahoga County Board of Health Office of Congresswoman Marcy Kaptur
Asian Services In Action (ASIA, Inc.) Cuyahoga County Council Office of Sen. Robert Portman
Birthing Beautiful Communities Department of Health and Human Services Office of Sen. Sherrod Brown
Care Alliance Health Center Fatherhood Initiative Office Rep. Fudge
CareSource Free Clinic Ohio Association of Health Plans
Case Western Reserve University Foundation Center Ohio Department of Health
Case Western Reserve University School of Medicine George Gund Foundation Ohio Department of Medicaid
The Center for Health Affairs The Good Community Foundation The Plain Dealer
The Centers for Families and
Children
Hispanic Pastors Association Radio One
City of Cleveland Invest in Children/Office of Early Childhood RUST, United Church of Christ
City of Cleveland, Public Health The Literacy Cooperative, Reach Out and Read Sisters of Charity Foundation
Cleveland City Council March of Dimes Sisters of Charity Health System
Cleveland Clinic
Medical Mutual of Ohio Saint Luke’s Foundation
cleveland.com The MetroHealth System State of Ohio, District 11
Cleveland Metropolitan School District MomsFirst Sure House Ministries
Community Members Mt. Sinai Health Care Foundation UH MacDonald Women’s Hospital
Center for Community Solutions Neighborhood Family Practice UH Rainbow Babies & Children's Hospital
Council for Economic Opportunities in Greater Clevela Neighborhood Leadership Institute
Cuyahoga County Executive Office Northeast Ohio Neighborhood Health Services
(NEON), Inc.
FYC’S THREE PRIORITIES FOR 2017-2020
Reduce Racial Disparities
Address Extreme Prematurity
Eliminate Sleep-related Deaths
“When a flower doesn’t bloom, fix the environment
in which it grows, not the flower.”
Alexander Den Heijer
“”“””While the mother is the environment of the developing fetus, the community is the environment of the mother.”
- Dr. Lawrence Wallack, “Going Upstream for the Health of the Next Generation”
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FIVE AREAS OF FOCUS
For these three priorities, FYC defines five areas of
focus that it will be held accountable for:
1. Establish Shared Measurement Practices
2. Support Coordinated Activities
3. Build Public Will
4. Advance Public Policy
5. Secure Funding
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STRATEGIC PLAN SUMMARY OVERVIEW
ActivityFYC Short-term Outcomes
2017-2018
FYC Intermediate Outcomes
2019-2020
Establish Shared
Measurement PracticesPartners understand the value of sharing data
Partners increasingly use shared data to adapt and
refine their strategies
Support Coordinated
Activities
Partners communicate and coordinate their
activities toward our three priorities - racial
disparities, prematurity, and safe sleep
Partners collaboratively develop new approaches
to advance the initiative
Build Public Will
The public develops a common understanding
of infant mortality and the need for action to
lower infant mortality rates
Increasing numbers of community members take
action on the issue
Advance Public PolicyPartners communicate and coordinate their
activities toward common policy goalsPolicy changes occur in line with initiative goals
Secure FundingFunders become more aware of the problem
and initiative goalsFunding is secured to support initiative activities
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C O L L A B O R AT I V E B OT TO M - U P A P P R O A C H W I T H A C O L L E C T I V E I M PA C T TO P D O W N
FYC Community Advisory Council• Unlimited number of members representing:
• Families who have had a loss
• Front line care givers
• Experts from research and provider community
• Community activists from public and private sectors, media, faith-based, civic, health, philanthropy, universities and social service agencies
FYC Executive Committee• 18 members include:
• 10 standing appointed members representing leadership of:
• MetroHealth, UH Rainbow Babies and Children’s Hospital and UH MacDonald Women’s Hospital, Cleveland Clinic, Cuyahoga County Executive Office, County Board of Health, City of Cleveland, Cleveland City Council, Cleveland Board of Health, and CWRU School of Medicine
• 6 rotating appointments representing public policy, philanthropy, corporate, faith-based community and providers
• 2 at-large Community Advisory Council Members 34
STAFFING - DESIGNED TO BE LEAN
Position Role Percent Effort
Case Western Reserve
University
School of Medicine
Fiscal Agent, FYC staff recruitment and hiring, HR, legal,
grants management, fund development, office space
Michael Konstan, MD
David Silvaggio
Elizabeth Littman
Executive Director
Staffs the Community Advisory Council and Executive
Committee, oversees FYC staff, day-to-day operations,
fundraising, external affairs, collaborations and Learning
Circles
1-Full-time Equivalent (FTE)
Project Manager, Racial
Disparities
Leads Racial Disparities Initiative, manages grants and
programs 1-FTE
Communications & Marketing
Expert
Oversees communications, marketing, public relations,
and public policy1-FTE
Data Systems Expert Data management 1-FTE
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WE NEED TO BE DISTRUPTIVE , CURIOUS AND COURAGEOUS
• FYC believes eliminating Sleep Related Infant Deaths is a Behavioral Modification Course of Action Example
MADD; Seat Belt Laws, Helmet Laws. What are the successful ingredients to changing individual behavior --
neighbor by neighbor, street by street– faith-based, CHW, Schools, Centering, Prenatal Care and Birthing
Hospitals. We are seeking a collective movement of action.
• Why does Cuyahoga County have the highest extreme premature deaths , born 22 weeks and less, in the State??
Give us your Learning Hypotheis that FYC should research. Examples from other break out groups:
• Do Black women go to the ER more than white women when having early pregnancy complications? Does
that change the records that are kept.
• Is there a consistent standard to recording birth certificates and death certificates of pre-viable /non-
viable fetuses throughout our community and state wide?
• What aspects of racial disparities in Cuyahoga have the biggest influence on infant
death? What do you recommend ?as a short term action plan
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BREAKOUT
PLAN OF ACTION JULY 2017 – JUNE 2018YEAR 1 : AL IGN AN D CO O RDINATE
ALIGN MEDIC AL WITH HO ME VIS ITO RS AN D FAITH- BAS ED AND CO LLEC T DATA
Organization
• Hire staff
• Kick off Advisory and
Executive Committees
• Launch subcommittees
• Develop three-year
operational plan
• Create FYC website
• Begin sharing/publishing
agreed-upon data
• Manage ODM funded
programs: $4.9M
• Oversee 2-yr. startup: City-
County $2.0M
• Design sustainability plan
Racial Disparities
• Awareness Campaign –
develop and implement
• Research race and
maternal stress,
qualitative and
quantitative data
• Engage private insurance
companies
• Gain understanding from
African Americans
• Set 5-year metric goal
Prematurity
• Improve access to
progesterone
• Coordinate and align
prenatal care providers and
Home Visiting Programs
• Connect home visitors at
time of bereavement for
services
• Set standard protocols for
birth and death certificates
for 22 weeks and less
gestation
• Create Learning Circle
• Build awareness re spacing
guidelines and access to
LARC
Safe Sleep
• In-hospital, at birth, risk
assessment tool
• Publish monthly data
• Support Tobacco21
• Model MetroHealth’s
Sleep Ambassador
Program
• Create local ABC public
awareness campaign with
ODH and ODM
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PLAN OF ACTION JULY 2018 – JUNE 2019
YEAR 2: RESULTS THAT MATTER
Organization
• Finalize long-term parent organization
• Make course corrections as needed
• Manage ODM funded programs: $4.9M
• Oversee 2-yr. startup: City-County $2.0M
• Implement sustainability plan
Racial Disparities
• Monitor and publish data
• Stress interventions w/ Centering Pregnancy
• Secure funding for children’s programming
• Coordinate integrated model across all sectors’ leadership around structural racism
Prematurity
• Host annual conference on promising practices
• Publish results on progesterone intervention
• Standardize practices regarding birth and death certificates
• Publish data
• Implement One Key Question
• Support family planning
Safe Sleep
• Faith-based led, culturally sensitive behavior change plan
• Conduct grass roots activities, Conversations for Families
• Engage with Fathers’ organizations
• Launch local ABC public awareness campaign with ODH and ODM
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PLAN OF ACTION JULY 2019 – JUNE 2020
YEAR 3: LEAD THE WAY
Organization
• Present at national conferences
• Publish FYC’s work
• Serve as a national model
• Innovate and train others
• Achieve sustainability
Racial Disparities
• Establish University R&D focused on systems issues impacting African American infant deaths
• Ensure that race as an issue is never overlooked in policy or in distribution of infant mortality funds
Prematurity
• Monitor to ensure that standard practices for birth and death certificates are maintained
• With March of Dimes, ensure Cuyahoga County has the resources to be a leader on prematurity research
Safe Sleep
• Train City and County employees working with all ages on ABC to reinforce safe sleep in all homes visited
• Continue local ABC public awareness campaign with ODH and ODM
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QUESTIONS AND DISCUSSION
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FYC CONTACT INFORMATION
Jennifer Bailit, Celina Cunanan Co-Chairs to FYC Community Advisory Council
The MetroHealth System
Bernadette Kerrigan
Executive Director
First Year Cleveland
Case Western Reserve University School of Medicine
10900 Euclid Avenue / BRB109H
Cleveland, Ohio 44106
Email: [email protected]
Work: 216-368-6870
Cell: 216-469-5986
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