Michigans Interconception Care Project

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Michigans Interconception Care Project

• Goal To keep more African American babies alive
  and healthy in each MI community

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Race specific Infant Mortality Rate Michigan
compared to US
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Michigans Disparity Ratio
B/W ratio 2.8
B/W ratio 3.1
Source Michigan Vital Statistics, 1989-2006,
Michigan Department of Community Health
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Leading Causes of Infant Death (2006)from Death
Certificates
57
Source Michigan Vital Statistics, Michigan
Department of Community Health
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Background

• No obstetrical or prenatal assessment or
  intervention has been successful in predicting or
  preventing a womans first preterm/LBW delivery
  (Rawlings, J. S., V. B. Rawlings and J. A. Read.
  "Prevalence of low birth weight and preterm
  delivery in relation to the interval between
  pregnancies among white and black women." NEJM
  1995, 332 69-74)
• The single best predictor of a preterm/LBW
  delivery is a history of a previous preterm/LBW
  delivery (Goldenberg, R. L. and D. J. Rouse.
  "Prevention of premature birth." New England
  Journal of Medicine 1998, 339(5) 313-20)

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Interconception Care is

• a set of interventions that aim to identify and
  modify biomedical, behavioral, and social risks
  to a womans health or pregnancy outcome through
  prevention and management.
• steps taken before conception and particularly
  after a prior poor outcome
• more than a single visit

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11 Michigan Communities funded for
Interconception Care Projects
Keweenaw
Houghton
Baraga
Ontonagon
Luce
Gogebic
Marquette
Alger
Chippewa
Schoolcraft
Iron
Mackinac
The 11 communities account for 66 of all births,
and 93 of Black births in Michigan.
Approximately 71 of Michigans infant deaths
and 92 of Black deaths occur in these
communities.
Dickinson
Delta
Menominee
Emmet
Cheboygan
Presque Isle
Charlevoix
Mont-morency
Alpena
Antrim
Otsego
Leelanau
Alcona
Crawford
Oscoda
Kalkaska
Grand
Benzie
Traverse
Missaukee
Iosco
Ogemaw
Wexford
Roscommon
Manistee
Arenac
Gladwin
Clare
Lake
Osceola
Mason
Huron
Bay
Midland
Isabella
Mecosta
Oceana
Newaygo
Tuscola
Sanilac
Montcalm
Saginaw
Gratiot
Muskegon
Lapeer
Genesee
St. Clair
Kent
Shiawassee
Clinton
Ionia
Ottawa
Macomb
Oakland

Ingham
Livingston
Allegan
Barry
Eaton
Van Buren
Wayne
Washtenaw
Calhoun
Jackson
Kalamazoo
City of Detroit, Out-Wayne County
Monroe
Branch
Hillsdale
Lenawee
Cass
St. Joseph
Berrien
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Initiatives Focused activities

• Fewer Preterm Births
• Fewer LBW Births
• Fewer Unplanned Pregnancies
• Fewer Pregnancies with lt 18 month intervals

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Model Program Elements

• Identify at-risk women
• recent pre-term birth (lt37 wks gest)
• recent VLBW birth (lt1500 grams)
• fetal death (stillbirth)
• neonatal death (up to 28 days of life)
• Nursing/medical/genetic risk assessment
• Grief support
• Contraception access
• Access to a medical home
• Case management up to 24 months

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Program Elements (cont)

• Plan for the most optimal pregnancy
• Pregnancy interval of 18 months
• Prenatal care provider
• Folic acid 3-6 months prior to pregnancy
• Management of disease and infection
• Group prenatal childbirth education
• Perinatal high risk case management

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Evolution of the IM Program

• FY 2004-2005
• Assembled IM coalitions
• Completed Community Systems Analysis
• Engaged community stakeholders in the development
  of action plans to reduce infant mortality
• Improved Collaboration with other programs
  serving women and children

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Evolution of the IM Program

• FY 2005-2006
• Completed Community Systems Analysis
• Continued coalition building and community
  education activities
• Introduced concept of interconception care
• PPOR and community level data (FIMR and Focus
  Groups) provided guidance in this decision

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Evolution of the IM Program

• FY 2006-2007
• MDCH provided guidelines and assistance for the
  development and implementation of Interconception
  Care Workplans
• Prescriptive Models for the project were shared
• Interpregnancy Care Program, Grady Memorial
  Hospital, Atlanta, GA
• Interconception Health Promotion Initiative,
  Denver Health, Denver, CO

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Evolution of the IM Program

• FY 2007-2008
• Implement Interconception Care workplans
• Utilize interventions for interconception care
  that are
• Evidenced based
• Sustainable
• Transition the role of the Coalition into one of
  an advisory group

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Improvement in Black Infant Mortality Rates over
5 year period 2002 - 2006
Michigan 2002 18.4, 2006 14.8
Black IM Rate 2002, Black IM Rate 2006
Source Michigan Vital Statistics, 1989-2006,
Michigan Department of Community Health
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State Resources

• Sophia Hines
• [phone]
• hinessop_at_michigan.gov
• Cheryl Lauber
• [phone]
• lauberc_at_michigan.gov
• Rosemary Fournier(517) 335-8861fournierr1_at_michig
  an.gov