WelcomeWelcome

Perinatal Continuum of Care

Tulsa County 2007

From Community Service Council of Greater Tulsa’s Community Profile 2007

Family Health CoalitionFamily Health Coalition

Established in 1987 to improve access to prenatal care

109 members from 60 agencies, businesses, government and consumers

Local health system plan articulates with the Oklahoma State Department of Health 5 Year Plan for Maternal and Child Health (Title V)

Conducts on-going assessments and system evaluation

Conducts policy advocacy Conducts resource and grant development

Established in 1987 to improve access to prenatal care

109 members from 60 agencies, businesses, government and consumers

Local health system plan articulates with the Oklahoma State Department of Health 5 Year Plan for Maternal and Child Health (Title V)

Conducts on-going assessments and system evaluation

Conducts policy advocacy Conducts resource and grant development

Family Health Coalition

Community HealthNet

Steering Committee

Social Marketing

Access Committee

System Evaluation

Tulsa HispanicResource Association

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Outreach (Babyline & Free

Pregnancy Testing)

Case Management (Healthy Start, Children First &

Healthy Families)

Client Education (Prenatal, Sexuality &

Social Marketing)

Provider Training

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Prenatal Health Care Providers

Indian Health Care Resource Center

Tulsa Health Department

OU (OB/Gyn & Family Medicine)

Planned Parenthood

OSU (OB/Gyn & Family Medicine)

Morton Comprehensive Health Center

ServicesFamily PlanningPrenatal Care

Labor & DeliveryPre-conceptual Care

Inter-conceptual CarePsycho-social Screening

Risk Appropriate ReferralsTranslation

Behavioral Health Treatment

Reduction in Fetal & Infant Mortality

Reduction in Low Birth-Weight Babies

Reduction in Preterm Deliveries

Improved Access to Prenatal Care

Tulsa’s Perinatal Health Care System Works

Outcomes and Process Objectives

Outcomes and Process Objectives

Reduce fetal and infant mortality

Reduce low birth weight and very low birth weight infants

Reduce prematurity

Reduce fetal and infant mortality

Reduce low birth weight and very low birth weight infants

Reduce prematurity

Increase access and continuity in prenatal care

Reduce need for high risk obstetrical care

Reduce rate of no or late prenatal care

Increase access and continuity of family planning

Reduce unintended pregnancy

Reduce teen birth rate Increase capacity of CBO

to provide prenatal and intraconceptional care

Increase research and services in women’s health

Increase access and continuity in prenatal care

Reduce need for high risk obstetrical care

Reduce rate of no or late prenatal care

Increase access and continuity of family planning

Reduce unintended pregnancy

Reduce teen birth rate Increase capacity of CBO

to provide prenatal and intraconceptional care

Increase research and services in women’s health

Prepared by the Community Service Council of Greater Tulsa

Strategic Framework

Source: Substance Abuse and Mental Health Services Administration (SAMHSA.).

Organize community to profile needs, including community readiness

Mobilize community and build capacity to address

needs

Develop the prevention plan (activities,

programs & strategies

Implement prevention plan

Evaluate for results and sustainability

1: Assessment

2: Capacity

3: Planning4: Implementation

5: Evaluation

Sustainability & cultural competence

AssessmentAssessment

Review of Linked Birth and Death Certificate

Data 1991-2000 (Tulsa Health Department, 2004)

Analysis of Feto-Infant Mortality 1996-2000 (Tulsa

Health Department, 2004)

Assessment of Reproductive Indicators in Women of Minority Race and Ethnicity in

Eastern Oklahoma (Planned Parenthood of Arkansas and Eastern Oklahoma, 2005)

Barriers to Help-Seeking for Economically Disadvantages Parents and Children in Tulsa (Oklahoma State University, 2006)

Barriers to Early Prenatal Care: PRAMS 2000-2003 (Oklahoma State Department of Health, April 2007)

Review of Linked Birth and Death Certificate

Data 1991-2000 (Tulsa Health Department, 2004)

Analysis of Feto-Infant Mortality 1996-2000 (Tulsa

Health Department, 2004)

Assessment of Reproductive Indicators in Women of Minority Race and Ethnicity in

Eastern Oklahoma (Planned Parenthood of Arkansas and Eastern Oklahoma, 2005)

Barriers to Help-Seeking for Economically Disadvantages Parents and Children in Tulsa (Oklahoma State University, 2006)

Barriers to Early Prenatal Care: PRAMS 2000-2003 (Oklahoma State Department of Health, April 2007)

AssessmentAssessment

Babyline 1990-2004 Trend Report (Community Service Council,

2006)

Administrative Analysis of Prenatal Data Final Report (Oklahoma Foundation for Medical Quality, 2006)

Tulsa County Profile 2007 (Tulsa Health Department, 2007)

Community Profile of Tulsa County 2007 (Community

Service Council, 2007)

Preliminary Findings 2004 Infant Deaths (Tulsa Health

Department, 2007)

Babyline 1990-2004 Trend Report (Community Service Council,

2006)

Administrative Analysis of Prenatal Data Final Report (Oklahoma Foundation for Medical Quality, 2006)

Tulsa County Profile 2007 (Tulsa Health Department, 2007)

Community Profile of Tulsa County 2007 (Community

Service Council, 2007)

Preliminary Findings 2004 Infant Deaths (Tulsa Health

Department, 2007)

Prepared by the Community Service Council of Greater Tulsa

Infant Mortality RatesTulsa County and Oklahoma, 1980-2005

Source: Oklahoma State Department of Health

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

0

2

4

6

8

10

12

14

Number of infant deaths per 1,000 live births

Tulsa County

Oklahoma

Tulsa County 11.8 13.3 11.1 10.9 9.6 10.5 9.3 8.4 10.3 9.6 9.7 9.9 8.6 11.1 10.2 9.7 9.4 7.3 7.5 7.7 9.9 7 8.8 7.5 6.6 8.2

Oklahoma 13.4 12.4 13.4 10.6 10 10.2 9.3 8.5 8.3 8.1 9.2 9.5 8.7 8.7 8.7 8.6 8.7 7.7 8.9 8.7 8.8 7.5 8.1 7.9 7.9 8.1

In 2005, there were 76 infant deaths in Tulsa County, for rate of 8.2 per 1,000 live births; in the state, there were 418 infant deaths, for a rate of 8.1

“Healthy People 2010” goal = 4.5 per 1,000

Infa

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Tulsa County, All Eligible Babies, 1996-2000, Feto-Infant Deaths grouped

by Maternal RaceMaternal Health/ PrematurityWhite, NonHisp = 2.31 (70)African American= 4.02 (26)Native American = 2.18 (6)Hispanic= 4.65 (16)Other= 0

Maternal CareWhite, NonH= 1.29 (39)Afr. Amer.= 2.63 (17)Nat. Amer. = 1.82 (5)Hispanic= 9.00 (31)Other= 3.62 (3)

Newborn CareWhite, NonH= 1.52 (46)Afr. Amer.= 2.16 (14)Nat. Amer. = 1.09 (3)Hispanic= 0.87 (3)Other= 2.41 (2)

Infant HealthWhite, NonH= 1.42 (43)Afr. Amer.= 2.94 (19)Nat. Amer. = 2.54 (7)Hispanic= 1.74 (6)Other= 1.21 (1)

Maternal Race

Cumulative IMRs:

White, NonHsp=6.54

Afr. Amer.=11.75

Nat. Amer.= 7.63

Hispanic= 16.26

Other= 7.24

Excluded: 38 live births w/out race data; 5 deaths, 442 births missing HispEthnicity; 130 with data outside PPOR criteria PPORt Dataset

3/24/04

Tulsa Fetal-Infant Mortality Review

Tulsa Fetal-Infant Mortality Review

Tulsa’s Perinatal System CapacityTulsa’s Perinatal System Capacity

Social MarketingSocial Marketing

Client

Outreach Case Finding Free Pregnancy Testing Planline/Family Planning

Babyline/Risk Assessment/Case Management Referral

CHC IHCRC Morton OSU OB/GYN

OU Family Med

PP THD

High Risk Care

Low and Moderate Risk Care

MortonPrivate Doctors

OSUOU

OB/GYN

Deliveries

OSU

Med CtnrSouthcrestHillcrest

Postpartum & Family Planning

CHC MortonIHCRC OSUOU Family

MedPP THD

Evidence Based StrategiesEvidence Based Strategies

Outcome performance measures Community coalitions

Collaborative, public-private partnerships Consumer/client investments

Outreach and recruitment Services (prenatal, family planning, women’s

health) Case management/Care coordination Social marketing Risk reduction education Access to services and care

Child care Transportation Translation

Outcome performance measures Community coalitions

Collaborative, public-private partnerships Consumer/client investments

Outreach and recruitment Services (prenatal, family planning, women’s

health) Case management/Care coordination Social marketing Risk reduction education Access to services and care

Child care Transportation Translation

Navigating Tulsa’s Perinatal System Navigating Tulsa’s Perinatal System

Social MarketingSocial Marketing

Client

Outreach Case Finding Free Pregnancy Testing Planline/Family Planning

Babyline/Risk Assessment

CHC IHCRC Morton OSU OB/GYN

OU Family Med

PP THD

High Risk Care

Safety Net/ Low and Moderate Risk Care

MortonPrivate Doctors

OSUOU

OB/GYN

Deliveries

OSU

Med CtnrSouthcrestHillcrest

Safety Net/Post-partum & Family Planning

CHC MortonIHCRC OSUOU Family

MedPP THD

Service

•Uninsured pool for prenatal care

•High risk obstetrical care stabilized

•Family planning for the uninsured

Access

•Expansion of all 3 case management

programs

•Expansion of risk appropriate referrals (Housing, Grieving support, translation,

smoking cessation, etc)

Preconceptional & Interconceptional Care

•Education

•Babyline & Planline

•Free Pregnancy Testing Program

•Social marketing

•Teen pregnancy prevention$2,173,980 annual

$3,781,433 annual

$1,464,730 annual

Est. $12M endowed

$1,454,149 annual

$1,513,280 annual

Research

•TFIMR

•Women’s Health Research

Center$1,399,879 annual

Wild CardsWild Cards

HB 1804 Immigration BillUnborn Child LegislationMedicaid for dental coverage

during pregnancyDecrease in Title V funding

HB 1804 Immigration BillUnborn Child LegislationMedicaid for dental coverage

during pregnancyDecrease in Title V funding

Prepared by the Community Service Council of Greater Tulsa

Summary of Risk Factors for InfantsTulsa County and Oklahoma, 2005

Source: Oklahoma State Department of Health, Vital Statistics.

11.6%

41%

7%

24.6%

6.3%

1.6%

33.5%

19.2%

11%

12.9%

39.1%

5.6%

22.4%

6.6%

1.4%

32.8%

19.1%

10.6%

Teen mother(age 15-19)

Unmarried mother

Poor prenatal care(3rd trimester/no care)

Mother w/ <12th gradeeducation

Low birthweight(1500-2499 grams)

Very low birthweight(<1500 grams)

Short birth spacing(<24 mos. apart)

Very short birth spacing(<18 mos. apart)

Premature(<37 weeks gest.)

0% 10% 20% 30% 40% 50%

Percent of Births

Tulsa Co.

Oklahoma

Tulsa County births: 9,297Oklahoma births: 51,775

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Prepared by the Community Service Council of Greater Tulsa

Characteristics of Births to Teen Mothers (Age 15-19)Tulsa County and Oklahoma, 2005

Source: Oklahoma State Department of Health, Vital Statistics.

84%

11.2%

63.4%

7.8%

2.4%

64%

40.1%

11.4%

23%

3.6%

78.4%

8.5%

54.9%

7.6%

1.8%

64.8%

42.9%

10.6%

20.9%

3.5%

Unmarried

Poor prenatal care(3rd trimester/no care)

Mother w/ <12th gradeeducation

Low birthweight(1500-2499 grams)

Very low birthweight(<1500 grams)

Short birth spacing(<24 mos. apart)

Very short birth spacing(<18 mos. apart)

Premature(<37 weeks gest.)

1+ previous births

2+ previous births

0% 20% 40% 60% 80% 100%

Percent of Teen Births

Tulsa Co.

Oklahoma

Tulsa County births to teens: 1,080Tulsa County teen birth rate: 57.8 (per 100,000 females age 15-19)

Oklahoma births to teens: 6,682Oklahoma teen birth rate: 54.2 (per 100,000 females age 15-19)

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Prepared by the Community Service Council of Greater Tulsa

Teen Mothers and Poor Birth Outcomes

Source: Oklahoma State Department of Health, Maternal, Infant and Child Health, 1997 Selected Demographic Information.

Risk Factor Teen Moms

Oklahoma ranked 8th in the nation in rate of births to teens in 2002.

42% higher20% lower81% higher86% higher2.7 times higher2.3 times higher23% higher30% higher

Low birth weight1st Trimester prenatal care3rd Trimester prenatal care

No prenatal careUnmarried

Short interval births (<24 months)Premature births (>3 weeks early)

Birth complications

Women under age 20, "teens," are more at risk of poor birth outcomes than are women age 20 & older.

Bir

ths

to T

eens

Prepared by the Community Service Council of Greater Tulsa

Resident Births by Marital Status of MotherTulsa County, 1980, 1990, 2000 and 2005

Source: Oklahoma State Department of Health.

7,143

6,6046,221

5,482

1,406

2,253

3,110

3,813

1980 1990 2000 20050

2,000

4,000

6,000

8,000

Number of births

Single Married

% Single 16.4 25.4 33.3 41

% Married 83.6 74.6 66.7 59Ris

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Prepared by the Community Service Council of Greater Tulsa

Resident Births, by Trimester of Entry into Prenatal CareTulsa County, 1980, 1990, 2000 and 2005

Source: Oklahoma State Department of Health, Vital Statistics.

64.2%

24.6%

9.0%

2.3%

69.6%

21.7%

6.9%1.7%

73.0%

18.9%

5.6%2.5%

70.3%

21.5%

6.9%1.3%

1st trimester 2nd trimester 3rd trimester or no care Unknown

1980 1990

2000 2005Ris

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Prepared by the Community Service Council of Greater Tulsa

Resident Births, by Trimester of Entry into Prenatal CareTulsa County, 1980, 1990, 2000 and 2005

Source: Oklahoma State Department of Health, Vital Statistics.

64.2%

24.6%

9.0%

2.3%

69.6%

21.7%

6.9%1.7%

73.0%

18.9%

5.6%2.5%

70.3%

21.5%

6.9%1.3%

1st trimester 2nd trimester 3rd trimester or no care Unknown

1980 1990

2000 2005Ris

k F

acto

rs fo

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fant

s •HIPAA barrier on transfer of medical records at 36 weeks

•Hispanic culture and self-pay

•Inadequate Medicaid global fee