Transcript Ruth Ann Shepherd, MD, FAAP Connie Gayle White, MD, MS, FACOG

Ruth Ann Shepherd, MD, FAAP
Director, Division of Maternal and Child Health
Kentucky Department for Public Health
Connie Gayle White, MD, MS, FACOG
Women’s Health Consultant
Founding Member, Every Woman Southeast
KY Partnerships on Prematurity
 Kentucky Folic Acid Partnership
 Since 1998; partnership with March of Dimes
 Over 100 members, 80 agencies across the state
 Prematurity Toolkit, HBWW project name
 Prematurity activities since 2005 (278,000 individual, 1.7M media)
 Prematurity Summits- MOD and KPA – spring and fall
 2004: “Prematurity, the Scope of the Problem” Frank Boehm
 2005: “The Prematurity Problem: The Kentucky Data”
 2006: “The Infant Born at 36 weeks is still Preterm”
 Kentucky Perinatal Association
 HPEP – Health Professional Education on Prematurity
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HPEP I - Pathways to Prematurity - 2005
HPEP II – Late Preterm Infants – 2007
HPEP III – Progesterone – 2009
 National Perinatal Association Awards to KPA
 Innovation Award 2006
 Best Chapter 2009
 Pilot Projects: PRAMS, FIMR, GIFTS
A Collaborative Partnership
• The Prematurity Prevention Partnership
 March of Dimes
 Johnson & Johnson Pediatric Institute
 Kentucky Department for Public Health
• Kentucky March of Dimes Chapter
• Professional organizations (ACOG, AAP, AWHONN)
• Kentucky perinatal leaders
Media Launch in Louisville, KY
March 2007
Dr. David Smith, Dr. Jennifer Howse, Governor Ernie
Fletcher, Dr. Steven Shelov, Mr. Shawn Crabtree
Overview
• HBWW® is a three year (2007-2009) pilot program that
aims to reduce “preventable” preterm births at three
Intervention Sites in Kentucky
 Goal: 15% reduction in the rate of singleton
preterm births at the intervention sites
 Mixed ecological “real world” design
 Focus on late preterm birth (34-36 weeks)
 Collaboration between hospitals, obstetricians, and
public health professionals and the local community
 Provides education for pregnant women, the
community and perinatal providers
HBWW Advisory Council
• Biannual Site Council Meetings with leaders representing:
 Participating agencies in KY (DPH: Commissioner, Director MCH,
HANDS Coordinator, State Epidemiologist, etc.)
 Perinatal professional organizations in KY (ACOG, AWHONN, KPA)
 State March of Dimes
 Intervention sites (both hospital and health dept each site)
 Executive Program Board (national partners and project PI)
 Clinical experts in ob/gyn, maternal fetal medicine, neonatology,
pediatrics, family medicine, oral health, smoking cessation
 Communications/media experts
• Working Groups
 Intervention, Evaluation, Communication, ad hoc
Healthy Babies are Worth the Wait Interventions
 “Bundled” Evidence-Based Interventions
 Linked elements of clinical care, patient support, and public education:
– Partnerships
Advisory Council, Local Implementation Teams,
Local meetings with office managers, etc.
– Professional Education & Action
• Grand Rounds & Training
• Standard clinical guidelines (folic acid, smoking
cessation, progesterone, screenings)
• Patient safety protocols
– Patient Education and Action
• Augmenting existing services for case management,
screening & referral
• Health Literacy in the context of prenatal care
– Public/ Community Education and Action
• Community Toolkit
• Media toolkit
• Web site
®
HBWW
Health Messages
•
See the doctor BEFORE & DURING pregnancy
•
Don’t smoke or use alcohol while pregnant
•
Take folic acid every day
•
Brush, floss and visit the dentist
•
Avoid scheduled delivery before 39 weeks
•
Babies’ brains grow a lot between 35 and 40 weeks
®
HBWW
Materials
Oral Health Products
•Stamped with website URL
Message Pens
Magnetic Photo Frames
Message Totes
•Incentives for follow-up
consumer survey
®
HBWW
Materials
Brain Card
•Not to be distributed
directly to patients
•Utilized by providers to
facilitate communication
with patients
Community Outreach Education & Action

Community Toolkit (KFAP)
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Media in Intervention Communities
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Message: Preventing Prematurity saves babies lives and improves the future for
families and for communities.
Fact Sheets, Handouts, Powerpoint, Instructions for Activities, Reporting form,
evaluation
English and Spanish
Media Toolkit for traditional media
Hospital and health department media teams
Digital media interventions
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www.prematurityprevention.org
Facebook, Twitter
State and National Outreach
- 26 state professional meetings
- 12 national meeting presentations
- nearly 100 media coverages
Web-based Resources:
www.PrematurityPrevention.org
Provider “Grade Card” sample
Summary of Inductions and Scheduled C/S of Infants prior to 39 wks GA
Total
Medical
Indication
Medical
Indication
Rate
Infants Admitted to
NICU Who Were
Induced or Sectioned
Without Medical
Indication
Doc A
5
5
100%
0
Doc B
3
1
33%
0
Doc C
2
2
100%
0
Doc D
3
2
66%
0
PHYSICIANS
Late Preterm Birth
Monthly Comparisons
(percent of deliveries)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
YR
Avg
2006
11
10
10
11
18
13
11
20
13
8
16
10
13
2007
14
21
13
12
10
11
12
11
7
9
8
13
12
2008
12
12
12
11
14
13
10
8
10
10
10
11
11
2009
6
7
7
13
19
7
6
9
8
11
6
11
9
Partnership Example
 Initial Grand Rounds included information on
periodontal disease and prematurity
 Discussions with providers  no local dentists would
see pregnant women
 From HBWW Advisory Committee, national oral
health expert (Dr. John Novak) agreed to provide
educational session
 HBWW team and Local Dental Society partnered to
sponsor combined educational session for medical and
dental providers
●After the educational session, some local dentists more
willing to accept pregnant patients
●HBWW team meeting with OB office managers got
feedback that only some dentists were participating
●HBWW team followed up with each local dentist,
providing additional materials and answering remaining
questions about dental care for pregnant women
●Additional dentists in the area agreed to provide dental
care for pregnant women
●Office mangers now reporting they are able to get women
in for dental care most of the time.