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Emerging Issues in MCH

Emerging Issues in MCH. Incorporating Preconception Health into MCH Services. Debra Bara MA. PPOR. Perinatal Periods of Risk Practice Collaborative. Sponsored by CityMatCH, UNMC Partners included National Offices of March of Dimes Centers for Disease Control and Prevention.

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Emerging Issues in MCH

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  1. Emerging Issues in MCH Incorporating Preconception Health into MCH Services Debra Bara MA PPOR

  2. Perinatal Periods of Risk Practice Collaborative • Sponsored by CityMatCH, UNMC • Partners included • National Offices of March of Dimes • Centers for Disease Control and Prevention

  3. Practice Collaborative Members • Teams from 16 cities that included: • Policy Representative • Data Representative • Community Representative • Met to “refine the practice” of PPOR and adapt for use in urban cities in industrialized country.

  4. OVERVIEW • Perinatal Periods of Risk • Both a DATA ANALYSIS TOOL and an APPROACH to identify critical gaps in the maternal and child health system that lead to infant mortality.

  5. OVERVIEW • PPOR Differs from conventional analysis • In addition to AGE AT DEATH, PPOR takes into account the BIRTH WEIGHT, an equally important predictor of survivability.

  6. OVERVIEW • PPOR differs from conventional analysis: • Utilizes LINKED birth and death records, which allows investigators to sort and study variables on the birth certificates, which is generally more complete that death certificate records alone.

  7. OVERVIEW • PPOR differs from conventional analysis • Combines fetal and infant deaths in a “feto-infant” death rate. • Includes fetal deaths as over 24 weeks, live births greater than 500 grams, (excluding spontaneous and induced abortions) • Ensures comparability of data (reference group)

  8. OVERVIEW • Feto-infant mortality rates are “mapped” according to the time of death and weight Age at death Fetal 24+ wks. Neonatal Postneonatal Birth Weight Maternal Health Maternal Care Newborn Care Infant Health

  9. DATA LEADS TO ACTION ! Maternal Health/ Prematurity • Preconception Health • Health Behaviors • Perinatal Care • Prenatal Care • High Risk OB Referrals • Insurance Coverage Maternal Care • Perinatal Management • Neonatal Care • Pediatric Surgery Newborn Care • Sleep Position • Breast Feeding • Injury Prevention Infant Health

  10. Infection Stress and Work General state of health prior to pregnancy Injuries and abuse Family planning Nutrition Tobacco/alcohol/drug use Previous pregnancyoutcomes Maternal HealthRisk Factors

  11. Nutrition during pregnancy Late/inadequate PNC Treatment of infection Poor weightgain Tobacco/alcohol/drug use during pregnancy Lack of recognition of problems needing care Recognition/management of early labor Obesity Maternal CareRisk Factors

  12. Availability of neonatal intensive care Prevention of infection Recognition of emergencysituation Obstetric expertise Pediatric expertise Regular newborn care including feeding/well baby care. Newborn CareRisk Factors

  13. Prevention & treatment of infection Recognition of birth defects/developmental anomalies Prevention/treatment of injuries Recognition of signs & symptoms of illness Failure to obtain well-child care or follow-up for illness SIDS prevention Infant HealthRisk Factors

  14. What it tells us • Opportunity gaps • Uses a “comparison group” model to quantify the specific opportunity to improve • United States “reference group” is white women, 13+ years of education, over 20 years of age, married.

  15. Common Finding across Cities • Maternal Health was greatest opportunity for improvement • Infant Health was most frequent second opportunity • Often documented racial disparity issues as occurring in Maternal Health Cell

  16. National PPOR Rates by Race/Ethnicity,by Period of Risk Components, for Resident Mothers 20+ years age, 13+ years of education in US, 1998-2000 (Table 6.3)

  17. Implications Changes in Practice Program & Policy

  18. PRACTICE • EXAMPLES-Integrating pre and interconceptional care into existing services • Family Planning Clinics • Home Visitation services • Developing risk screening process for non-pregnant population of women

  19. Risk assessment Women’s Health questionnaire-25 questions Access to Health Care, Maternal Infections, Baby Spacing Nutrition & Physical Activity Chronic Health Issues Stress & Mental Health Environmental Health Interventions Home Visitation Staff linking non-pregnant patients to: Smoking cessation services Domestic violence prevention, MH services, including drug treatment Health Care Program- EXAMPLEHealthy Start Home Visitation Services

  20. Policy • Answer questions “who do we serve & how?” • What programs need to be organizationally connected for optimum service to women throughout the life span? • Funding Implications • Research Implications

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