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Using Data to Kick Start an OB Navigator Program in Indiana

Using Data to Kick Start an OB Navigator Program in Indiana. Cameron Mere, Rachel Pfafman, Ryan Ahmed, Shauna Wagner. Background. IN ranks as the 7 th worst state in the US in regards to infant mortality at 7.3% in 2017 1

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Using Data to Kick Start an OB Navigator Program in Indiana

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  1. Using Data to Kick Start an OB Navigator Program in Indiana Cameron Mere, Rachel Pfafman, Ryan Ahmed, Shauna Wagner

  2. Background • IN ranks as the 7th worst state in the US in regards to infant mortality at 7.3% in 20171 • The state has made it a top priority to reduce infant mortality rates by 2024 • “A mother’s stress exposure and her affective states in pregnancy may have significant consequences for her child’s subsequent development and health”2 • Further, “little research thus far has examined the feasibility and utility of screening for prenatal stress or pregnancy anxiety”2 1Stats of the States - Infant Mortality. (15 Jan 2019). Retrieved from https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm 2Dunkel Schetter, C., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Current opinion in psychiatry, 25(2), 141–148. doi:10.1097/YCO.0b013e3283503680

  3. ASSESSMENT Rural and mixed counties display greater percentages of ER visits, obesity, diabetes, pre term delivery, substance use, and stress

  4. ASSESSMENT • Positive correlations between: • Stress and ER visits (p=0.0005) • Diabetes and preterm delivery (p=0.0037) • Diabetes and ER visits (p=0.0098) • Diabetes and stress (p=0.0000) • Substance use and ER visits (p=0.0008) • Substance use and stress (p=0.0000) • Substance use and diabetes (p=0.0001) • Obesity and stress (p=0.0007) • Obesity and diabetes (p=0.0329) • Obesity and substance use (p=0.0000) • *Correlated amongst all counties

  5. ASSESSMENT • Positive correlations between: • Stress and ER visits (p=0.0005) • Diabetes and preterm delivery (p=0.0037) • Diabetes and ER visits (p=0.0098) • Diabetes and stress (p=0.0000) • Substance use and ER visits (p=0.0008) • Substance use and stress (p=0.0000) • Substance use and diabetes (p=0.0001) • Obesity and stress (p=0.0007) • Obesity and diabetes (p=0.0329) • Obesity and substance use (p=0.0000) • *Correlated amongst all counties

  6. Assessment The percentage of mothers who smoked during pregnancy was higher in rural/mixed counties.

  7. ASSESSMENT • The percentage of birth complications is higher in mothers who smoked during pregnancy

  8. ASSESSMENT • Mothers who smoked during pregnancy have a higher percentage of child mortality within the first year

  9. ASSESSMENT • Mothers who smoked during pregnancy have a higher percentage of low birth weight babies

  10. ASSESSMENT • Literature shows that effects of maternal stress on low birth weight and pre term delivery outcomes may be different for mothers living in different neighborhood contexts • Our analysis of our population confirms this (p<0.0001). Nkansah-Amankra, S., Luchok, K.J., Hussey, J.R. et al. Matern Child Health J (2010) 14: 215. https://doi.org/10.1007/s10995-009-0447-4

  11. assessment Mothers who are never married have the highest percentage of child mortality before their first birthday Mothers 25-35 experience the greatest percentage of infant mortality at the hospital

  12. assessment Mothers who are married have the highest percentage of visiting the doctor within the first trimester Mothers <14 and >45 breastfeed less when compared to mothers in other age groups

  13. recommendations Investigate Stress Claims: • OB navigators can investigate these claims to identify the stressors on an individual basis.  • Assess where the stressors fall on the hierarchy of human needs?  • Implement resources targeted at the individual's specific area of stress.

  14. recommendations • The usage of an app-based dashboard by OB navigators and leaders at the state to help drive resource allocation and provide the best care for the recipients of the program • Extending resources such as AskLiv.com to Indiana mothers - gain access to participant utilization data to prioritize interventions • Surveying the recipients of the program about their individual needs to help guide OB navigator efforts using known validated survey instruments  • Push out periodic “how are you today?” messages as in Experience Sampling Method via text to track changes in moods and/or behaviors 

  15. recommendations Tools built to assist the OB navigator must: • Identify the most at risk women and children • Assess individual circumstances • Measure the outcomes of OB navigator interventions • The following slide is an example of a mock dashboard, designed as a tablet screen, to be utilized by the OB navigators

  16. McIntosh, Gemma Roanoke 33 years, remarried Huntington, rural majority Top 3 Areas of Concern in County Pre-Term Delivery Substance Use Claims Stress Related Claims 27% 56% 53% Huntington 17% 48% 45% IN average Expand Relevant Surveys for Huntington County, IN Recommended Support Resources Work and Social Adjustment Survey Drinking alcohol while pregnant. Best practice advice. Holmes-Rahe Stress Inventory Premature labor. Dangers and causes of premature labor. Alcohol, Smoking, and Substance Involvement Screening Test Presumptive Eligibility for Pregnant Women (PEPW). Program to pay for health care. All support resources All surveys

  17. McIntosh, Gemma Roanoke 33 years, remarried Huntington, rural majority This search box will allow you to look at statistics based on the county This search box will provide pertinent information as it relates to their program recipient Top 3 Areas of Concern in County Pre-Term Delivery Substance Use Claims Stress Related Claims 27% 56% 53% Huntington 17% 48% 45% IN average Expand Relevant Surveys for Huntington County, IN Recommended Support Resources Work and Social Adjustment Survey Drinking alcohol while pregnant. Best practice advice. Holmes-Rahe Stress Inventory Premature labor. Dangers and causes of premature labor. Alcohol, Smoking, and Substance Involvement Screening Test Presumptive Eligibility for Pregnant Women (PEPW). Program to pay for health care. All support resources All surveys

  18. McIntosh, Gemma Roanoke 33 years, remarried Huntington, rural majority Top 3 Areas of Concern in County Pre-Term Delivery Substance Use Claims Stress Related Claims 27% 56% 53% Huntington 17% 48% 45% IN average Expand Based on county selection, the following style of information can show the top areas of concern based on the county’s average vs the state average Relevant Surveys for Huntington County, IN Recommended Support Resources Work and Social Adjustment Survey Drinking alcohol while pregnant. Best practice advice. Holmes-Rahe Stress Inventory Premature labor. Dangers and causes of premature labor. Alcohol, Smoking, and Substance Involvement Screening Test Presumptive Eligibility for Pregnant Women (PEPW). Program to pay for health care. All support resources All surveys

  19. McIntosh, Gemma Roanoke 33 years, remarried Huntington, rural majority Top 3 Areas of Concern in County Pre-Term Delivery Substance Use Claims Stress Related Claims 27% 56% 53% Huntington Relevant survey instruments recommended based on the top issues for the county Available support services in the county based on the answers to the surveys by the recipient 17% 48% 45% IN average Expand Relevant Surveys for Huntington County, IN Recommended Support Resources Work and Social Adjustment Survey Drinking alcohol while pregnant. Best practice advice. Holmes-Rahe Stress Inventory Premature labor. Dangers and causes of premature labor. Alcohol, Smoking, and Substance Involvement Screening Test Presumptive Eligibility for Pregnant Women (PEPW). Program to pay for health care. All support resources All surveys

  20. recommendations • Supply OB navigators with real-time reporting of stress claims in an easy to use dashboard • Identify when stress claims are coupled with other risk factors such as substance use • Utilize text messaging to mothers to assess individual situations • Ask questions related to physiological and safety needs • Create interventions based on individualized assessments of the family unit • Implement survey instruments to measure outcomes • Push resources to mothers and families via mobile platform • AskLiv.com • Routine check-in messaging to allow mothers to report new stressors routinely

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