Transcript Slide 1

Welcome
Perinatal Continuum of
Care
Tulsa County 2007
From Community Service Council of Greater Tulsa’s Community Profile 2007
Family Health Coalition
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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
Steering Committee
Social Marketing
Access Committee
System Evaluation
Community HealthNet
Tulsa Hispanic
Resource Association
Improved Access to Prenatal Care
Reduction in Fetal & Infant Mortality
Reduction in
Low Birth-Weight Babies
Reduction in
Preterm Deliveries
Tulsa’s Perinatal Health Care System Works
Prenatal Health Care Providers
Outreach
Services
Indian Health Care Resource Center
(Babyline & Free
Pregnancy Testing)
Family Planning
Prenatal Care
Labor & Delivery
Pre-conceptual Care
Inter-conceptual Care
Psycho-social Screening
Risk Appropriate Referrals
Translation
Behavioral Health Treatment
Tulsa Health Department
Case Management
OU (OB/Gyn & Family Medicine)
(Healthy Start, Children First &
Healthy Families)
Planned Parenthood
Client Education
OSU (OB/Gyn & Family Medicine)
(Prenatal, Sexuality &
Morton Comprehensive Health Center
Social Marketing)
Contributions.
Corporate Giving
Philanthropy
(Federal Money
Indian Health
Service
(Federal Money
Graduate Medical
Educational Funding
(Federal Money
Healthy Start
Funding
(Federal Money
Office of Child
Abuse Prevention
Funding
(Federal Money
WIC Funding
(Federal Money
Title XFunding
(Federal Money
Title V Funding
Money
GQHC/330
Funding (Federal
(Blend of Federal
& State Monies
Medicaid Funding
Provider Training
Outcomes and Process
Objectives
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Reduce fetal and infant
mortality
Reduce low birth
weight and very low
birth weight infants
Reduce prematurity
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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
Strategic Framework
1: Assessment
Organize community to
profile needs, including
community readiness
5: Evaluation
2: Capacity
Evaluate for results and
sustainability
Mobilize community and
build capacity to address
needs
Sustainability &
cultural competence
4: Implementation
Implement prevention
plan
3: Planning
Develop the prevention
plan (activities,
programs & strategies
Source: Substance Abuse and Mental Health Services Administration (SAMHSA.).
Prepared by the Community Service Council of Greater Tulsa
Assessment
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Review of Linked Birth and Death Certificate Data
1991-2000
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(Tulsa Health Department, 2004)
Analysis of Feto-Infant Mortality 1996-2000
(Tulsa Health
Department, 2004)
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Assessment of Reproductive Indicators in Women of
Minority Race and Ethnicity in Eastern Oklahoma
(Planned
Parenthood of Arkansas and Eastern Oklahoma, 2005)
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Barriers to Help-Seeking for Economically
Disadvantages Parents and Children in Tulsa (Oklahoma State
University, 2006)
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Barriers to Early Prenatal Care: PRAMS 2000-2003
(Oklahoma State Department of Health, April 2007)
Assessment
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Babyline 1990-2004 Trend Report (Community Service Council, 2006)
Administrative Analysis of Prenatal Data Final Report
(Oklahoma Foundation for Medical Quality, 2006)
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Tulsa County Profile 2007 (Tulsa Health Department, 2007)
Community Profile of Tulsa County 2007 (Community Service Council,
2007)
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Preliminary Findings 2004 Infant Deaths (Tulsa Health Department,
2007)
Infant Mortality Rates
Tulsa County and Oklahoma, 1980-2005
Number of infant deaths per 1,000 live births
14
Tulsa County
Oklahoma
12
8
6
4
In 2005, there w ere 76 infant deaths in
Tulsa County, for rate of 8.2 per 1,000
live births; in the state, there w ere 418
infant deaths, for a rate of 8.1
2
“Healthy People 2010”
goal = 4.5 per 1,000
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
0
1980
Infant Mortality
10
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
Source: Oklahoma State Department of Health
Prepared by the Community Service Council of Greater Tulsa
Tulsa Fetal-Infant Mortality
Review
Tulsa County, All Eligible Babies,
1996-2000, Feto-Infant Deaths grouped
by Maternal Race
Maternal Health/ Prematurity
White, NonHisp =
African American=
Native American =
Hispanic=
Other=
2.31 (70)
4.02 (26)
2.18 (6)
4.65 (16)
0
Maternal Care
Newborn Care
Infant Health
White, NonH= 1.29 (39)
Afr. Amer.= 2.63 (17)
Nat. Amer. = 1.82 (5)
Hispanic=
9.00 (31)
Other=
3.62 (3)
White, NonH= 1.52 (46)
Afr. Amer.= 2.16 (14)
Nat. Amer. = 1.09 (3)
Hispanic=
0.87 (3)
Other=
2.41 (2)
White, 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 Hisp
PPORt Dataset
Ethnicity; 130 with data outside PPOR criteria
3/24/04
Tulsa’s Perinatal System Capacity
Social Marketing
Client
Outreach Case Finding
Planline/Family Planning
Free Pregnancy Testing
Babyline/Risk Assessment/Case Management Referral
Low and Moderate Risk Care
CHC
IHCRC
Morton
OSU
OU
OB/GYN
Family Med
High Risk Care
Private
Doctors
Morton
OSU
PP
THD
Deliveries
OU
Hillcrest
OB/GYN
Southcrest
OSU
Med Ctnr
Postpartum & Family Planning
CHC
IHCRC
Morton
OSU
OU
Family
Med
PP
THD
Evidence Based Strategies
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Outcome performance measures
Community coalitions
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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
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Child care
Transportation
Translation
Navigating
Tulsa’s
PerinatalCare
System
Preconceptional
& Interconceptional
Social Marketing
•Education
Service
Outreach Case Finding
•Uninsured pool
for prenatal care
•Babyline & Planline
Client
•Free Pregnancy Testing Program
Free Pregnancy Testing
•Social marketing
•Teen pregnancy
prevention
Babyline/Risk Assessment
Planline/Family Planning
Access
•Expansion of all 3
•High risk
Safety Net/Research
Low and Moderate Risk Care case management
obstetrical care
CHC
IHCRC
Morton
OSU
OU
PP
THD
programs
OB/GYN
Family
Med
•TFIMR
stabilized
•Expansion of risk
High Risk Care
Deliveries
•Women’s
•FamilyPrivate
planning
appropriate
OSU
referrals
OU
Hillcrest
Southcrest
Morton
OSU
Health Research
Med Ctnr
for the Doctors
uninsured OB/GYN
(Housing, Grieving
Center
Safety Net/Post-partum & Family Planningsupport, translation,
OU
Family
smoking
cessation,
etc)
CHC
IHCRC
Morton
OSU
PP
THD
Med
Wild Cards
HB 1804 Immigration Bill
 Unborn Child Legislation
 Medicaid for dental coverage during
pregnancy
 Decrease in Title V funding
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Summary of Risk Factors for Infants
Tulsa County and Oklahoma, 2005
11.6%
12.9%
Teen mother
(age 15-19)
41%
39.1%
Risk Factors for Infants
Unmarried mother
7%
5.6%
Poor prenatal care
(3rd trimester/no care)
24.6%
22.4%
Mother w/ <12th grade
education
Tulsa Co.
Oklahoma
6.3%
6.6%
Low birthweight
(1500-2499 grams)
Very low birthweight
(<1500 grams)
1.6%
1.4%
33.5%
32.8%
Short birth spacing
(<24 mos. apart)
19.2%
19.1%
Very short birth spacing
(<18 mos. apart)
Premature
(<37 weeks gest.)
0%
11%
10.6%
10%
20%
Tulsa County births: 9,297
Oklahoma births:
51,775
30%
Percent of Births
Source: Oklahoma State Department of Health, Vital Statistics.
Prepared by the Community Service Council of Greater Tulsa
40%
50%
Characteristics of Births to Teen Mothers (Age 15-19)
Tulsa County and Oklahoma, 2005
84%
78.4%
Unmarried
11.2%
8.5%
Poor prenatal care
(3rd trimester/no care)
63.4%
Risk Factors for Infants
Mother w/ <12th grade
education
54.9%
7.8%
7.6%
Low birthweight
(1500-2499 grams)
Very low birthweight
(<1500 grams)
2.4%
1.8%
64%
64.8%
Short birth spacing
(<24 mos. apart)
40.1%
42.9%
Very short birth spacing
(<18 mos. apart)
(per 100,000 females age 15-19)
23%
20.9%
1+ prev ious births
0%
Tulsa County births to teens: 1,080
Tulsa County teen birth rate: 57.8
11.4%
10.6%
Premature
(<37 weeks gest.)
2+ prev ious births
Tulsa Co.
Oklahoma
Oklahoma births to teens:
Oklahoma teen birth rate:
3.6%
3.5%
6,682
54.2
(per 100,000 females age 15-19)
20%
40%
60%
Percent of Teen Births
Source: Oklahoma State Department of Health, Vital Statistics.
Prepared by the Community Service Council of Greater Tulsa
80%
100%
Teen Mothers and Poor Birth Outcomes
Women under age 20, "teens," are more at risk of poor birth outcomes
than are women age 20 & older.
Births to Teens
Risk Factor Teen M oms
Low birth weight
1st Trimester prenatal care
3rd Trimester prenatal care
No prenatal care
Unmarried
Short interval births (<24 months)
Premature births (>3 weeks early)
Birth complications
42% higher
20% lower
81% higher
86% higher
2.7 times higher
2.3 times higher
23% higher
30% higher
Oklahoma ranked 8th in the nation in rate of births to teens in 2002.
Source: Oklahoma State Department of Health, Maternal, Infant and Child Health, 1997 Selected Demographic Information.
Prepared by the Community Service Council of Greater Tulsa
Resident Births by Marital Status of Mother
Tulsa County, 1980, 1990, 2000 and 2005
Number of births
8,000
7,143
6,604
Risk Factors for Infants
6,221
6,000
5,482
3,813
4,000
3,110
2,253
2,000
1,406
Single
Married
0
% Married
% Single
1980
1990
2000
2005
83.6
16.4
74.6
25.4
66.7
33.3
59
41
Source: Oklahoma State Department of Health.
Prepared by the Community Service Council of Greater Tulsa
Resident Births, by Trimester of Entry into Prenatal Care
Tulsa County, 1980, 1990, 2000 and 2005
1980
1990
1.7%
6.9%
2.3%
9.0%
Risk Factors for Infants
64.2%
69.6%
21.7%
24.6%
1.3%
6.9%
2.5%
5.6%
70.3%
73.0%
18.9%
21.5%
2000
1st trimester
2005
2nd trimester
3rd trimester or no care
Source: Oklahoma State Department of Health, Vital Statistics.
Prepared by the Community Service Council of Greater Tulsa
Unknown
Resident Births, by Trimester of Entry into Prenatal Care
Tulsa County, 1980, 1990, 2000 and 2005
1980
1990
1.7%
6.9%
2.3%
9.0%
Risk Factors for Infants
64.2%
24.6%
69.6%
•HIPAA barrier on
transfer of medical
records at 36 weeks
21.7%
1.3%
6.9%
2.5%
5.6%
70.3%
73.0%
18.9%
•Hispanic culture and
self-pay
2000
1st trimester
21.5%
2005
2nd trimester
•Inadequate Medicaid
3rd trimester
global fee or no care
Source: Oklahoma State Department of Health, Vital Statistics.
Prepared by the Community Service Council of Greater Tulsa
Unknown