Infant Mortality in Ohio and the Region

 McKenna HSBy David McKenna, MD

There is sobering news for the State of Ohio on infant mortality, or death, within the first year of life. Nationally, Ohio ranks 48th overall and 49th for African-Americans. In 2011, 1,088 Ohio babies died before their first birthday. African- American babies had over twice the rate of infant death, compared to Caucasians. Clearly, this should attract the attention of Premier Health’s pediatricians, family physicians, and obstetricians/gynecologists. But it shouldn’t end with them, as infant mortality is a surrogate for the overall health of a population; therefore, Ohio’s poor infant mortality rankings speak to the care provided for all our patients.

Fortunately, the news is not all bad. Premier Health is leading several initiatives to reduce infant mortality, both statewide and locally. This started in 2009 when then-Premier CEO Tom Breitenbach co-chaired a statewide task force on infant mortality for Governor Strickland1. One of the task force’s recommendations was to establish an ongoing consortium to address infant mortality and disparities. In 2010, the Ohio Collaborative to Prevent Infant Mortality (OCPIM)2 was established for this purpose, and, in 2012, the Dayton/Montgomery County Infant Mortality Coalition (IMC) was established. Both have representation and leadership from Premier physicians, nurses, and administrators. Premier is also represented in a similar Butler County task force.

The Dayton/Montgomery County IMC was one of four urban sites chosen by CityMatch, a national leader in maternal child health promotion, to participate in the Equity Institute in Birth Outcomes project3. The Dayton/Montgomery County team is in the process of implementing an equity project to improve birth outcomes locally. The project consists of two interventions, progesterone treatment for high risk women to prevent preterm birth, and implementation of Centering Pregnancy®4, which is a group health care model. Both are evidenced-based interventions, which have been shown to decrease preterm birth, the leading cause of infant mortality.

Progesterone for the prevention of preterm birth has been used by many Premier physicians for years, but there is room for improvement in identifying more women who will benefit, and facilitating the access to the medication. This is being implemented across Premier by several mechanisms. The Ohio Perinatal Quality Collaborative (OPQC) has a $2 million grant for progesterone treatment for at-risk women in Ohio; Miami Valley Hospital is one of the founding members of OPQC, and a lead site for the progesterone project. The Center for Women’s Health at Five Rivers Health Center, as well as the MVH Department of Maternal-Fetal Medicine, are leading the project. Through the Premier Innovate Women’s Services team, a system-wide progesterone intervention is being launched, which is led by Gina McFarland-El, CEO of Five Rivers Clinics. This will provide the necessary tools to educate providers, and effectively screen, identify, and treat all at-risk women who might benefit from progesterone.

The Centering Pregnancy® model incorporates three major components: assessment, education, and support. Improved outcomes have been realized in preterm birth rates, low birth rates, breastfeeding rates, and immunization rates. Through improved outcomes, it has been estimated that in 2012 alone, centering saved over $40 million nationally. The Centering Pregnancy® model has been used for the past two years at Good Samaritan Hospital’s LifeStages, led by nurse midwife Jalana Lazar, and is being newly implemented at the Five Rivers Center for Women’s Health, as well as at the Community Health Centers of Greater Dayton’s Cassano Clinic.

On May 1, Premier launched its safe sleep program, which is a system initiative to teach and promote safe sleep practices for all families who deliver babies at Premier facilities. The program consists of pre-natal education, educational materials for parents to take home, and bedside teaching. Beginning this summer, a sleep sack, or wearable blanket, will be given to each mother. Safe sleep practices are effective in reducing two (SIDS and accidental suffocation) of the five major causes of infant mortality5. Please don’t hesitate to contact me if you have questions about any of these programs or would like to become involved. I have included several links below for further reading.

For further reading:

  1. 2009 Report from the Ohio Task Force on Infant Mortalilty.Off Site Icon
  2. The Ohio Collaborative to Prevent Infant Mortality.Off Site Icon
  3. CityMatch Equity Institute.Off Site Icon
  4. Centering Pregnancy.Off Site Icon
  5. Safe Sleep.Off Site Icon

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