Transcript FROM DATA TO ACTION:

DOING
PRECONCEPTIONAL
HEALTH:
LOCAL REALITIES
Marjorie Angert, D.O., MPH,
Director of Medical Affairs,
Division of Maternal, Child and Family Health,
Philadelphia Department of Public Health
PHILADELPHIA INFANT
MORTALITY, 1995-1998
Upper NE
Roxborough/
Manayunk
Germantown/
Chestnut Hill
Lower NE
Olney/
Oak Lane
Upper North
Bridesburg/
Kensington/
Richmond
West
Lower North
Center City
South
Southwest
Infant Mortality Rate (per 1,000 l
Philadelphia PPOR Results,
1997-99 (95% C.I.)
Maternal
Health/
Prematurity
Maternal
Care
Newborn Care Infant Health
Lower North HS 10.7
(8.1-13.8)
3.8
(2.3-5.9)
2.7
(1.5-4.5)
3.6
(2.2-5.6)
All Phila.
5.6
(5.0-6.2)
2.9
(2.5-3.3)
1.4
(1.1-1.7)
2.3
(2.0-2.7)
2.1
(1.2-3.3)
.85
(.3-1.8)
.85
(.3-1.8)
.61
(.2- 1.4)
n=65,849
Reference*
n=8233
*Philadelphia Residents, White, non-Hispanic,
13+years of education, 20+ years of age
PHASE II ANALYSIS
Chronic Hypertension
Previous Preterm Delivery
High Parity for Maternal Age
PARTNERS ASSEMBLED
Philadelphia Department of Public Health
(Division of Maternal, Child and Family
Health)
Healthy Start Staff
Health Clinic Providers and Staff
North Philadelphia Alliance
LINKING PPOR TO THE
COMMUNITY
Healthy Start has been working with the North
Philadelphia Alliance (community board): medical
providers, patients, CBOs, faith-based organizations
Team presented PPOR to the Alliance
Alliance and local partners learned risk factors for
prematurity and infant mortality in their community
PUTTING TOGETHER
LOCAL TEAM
Team identified local partners for strategic planning at
the health center:
MCFH staff: medical director and administrator for family
planning/gyn services; HS program manager, Consortium
developer and epidemiologist
Health Center staff: administrator, medical director, health
care coordinator, family planning nurse practitioner,
gynecologist, primary care provider, clerical staff and social
worker
INTERVENTION
STRATEGIES
Strategies will include the Healthy Start case
manager and require collaboration between family
planning and family medicine:
1. Women with a positive or negative pregnancy test will be
connected with Healthy Start at that visit.
2. Women seen in family planning who have medical risk factors
for preterm birth will be referred to Adult Medicine for treatment
and to Healthy Start for education and coordination of
interconceptional care.
3. Women with history of preterm birth will be referred to Healthy
Start for education and, if needed, case management services.
INTERVENTION
STRATEGIES (cont.)
4. We will meet with primary care staff to discuss their role in
decreasing infant mortality through preconceptional care:



Medical conditions and social behaviors predate the
pregnancy
40%-50% of pregnancies are unplanned
Need to integrate preconceptional screening into H & P
BARRIERS
Lack of knowledge among community and
medical providers about the importance of
preconceptional care
Limited opportunities to meet with medical
staff
Lack of screening tool for risk factors for
medical providers
Inadequate staff
BARRIERS (cont.)
Complicated consent and confidentiality
issues when two organizations (Health
Center and Healthy Start) collaborate
Need to understand at an emotional level
what it is like to have a premature baby or an
infant death
LESSONS LEARNED
PPOR data is powerful, but is only the first
step
All partners must be at the table early on and
be part of the process
Have the meetings on site and at regular
intervals
Recognize that the program evolves over
time - it is a process
LESSONS LEARNED
Community involvement is critical
Look for help from the institutions in your city
Evaluation is an important part of the process