DELAWARE SIM UPDATE December, 2006

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DELAWARE SIM UPDATEDecember, 2006
Delaware Health and Social Services Division of
Public Health

• Paul Silverman, Dr.P.H.
• Special thanks to
• Barbara Gladders, M.S.
• Charlan Kroelinger, Ph.D.

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State Trends Five-year Average Infant Mortality
Rates for Delaware and U.S., 1980-2004
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State Trends Racial Differences in Infant
Mortality, Delaware 1989 - 2004
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Other Contributing Trends in Infant Mortality for
Delaware, 1990 - 2003

• Multiple Births
• Total Increased, then leveled
• Blacks Downward trend
• Whites Upward trend
• VLBW and Very Premature (lt32 weeks) show similar
  pattern
• Increased from 94-98 to 98-02, then decreased
• Steeper increase for whites

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Other trends IM by County in Delaware 1997 - 2003
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Conclusions from Kitagawa Analysis

• One-thirdIncrease in extremely low birthweight
  black births
• Two-thirdsIncrease in birthweight-specific
  mortality rates of infants lt1,500 grams among
  black and white infants
• Black gt WhiteIncrease larger among black infants
  than white infants.

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Where to Begin?Research Framework for Delaware

• Increase in Extremely and Very LBW infants
• Vital Statistics Reporting
• Change in Socio-Economic Status
• Less Healthy Moms
• Substance Abuse
• Aggressive Pregnancy Management
• Assisted Reproductive Technology
• Increase in Birth Weight-Specific Mortality Rates
• Vital Statistics Reporting
• Assisted Reproductive Technology
• Less Healthy Moms
• Sicker Babies
• Perinatal Care

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State Assessment of Vital Records Reporting
State Infant Mortality Toolkit

• Juan Acuna
  Zarinah Ali
  Barbara Gladders
  Priscilla Guild
• Marian MacDorman Bill
  Sappenfield Tri Tran

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Opportunity Knocks in Delaware

• SIM Action Plan
• Build capacity for data analysis and research
• Develop and implement a research agenda
• Governors Infant Mortality Task Force Report
  (May 2005)
• Delaware Healthy Mother and Infant Consortium
• Recommendations Access and quality of care for
  prenatal, preconception, family planning, and
  neonatal transport research consumer education
• Fiscal Year 2006 1 million
• Fiscal Year 2007 3 million

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SIM Build Capacity for Data Analysis and
Research

• New Center for Excellence in MCH and Epidemiology
• MCH Epidemiologist from CDC began in August 2005
• 3 New FTEs dedicated to implementing the IM
  recommendations
• Recruiting CSTE and university fellows
• Partnering on research proposals

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SIM Build Capacity for Data Analysis and
Research

• FIMR (Fetal Infant Mortality Review)
• PRAMS (Pregnancy Risk Assessment Monitoring
  System)
• Registry for Improved Birth Outcomes (1989
  2003)
• Multi-site prospective cohort study of women from
  the 1st prenatal visit to 2 years post partum
• Multi-site study of preconception care expansion
  in Delaware

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SIM Develop and Implement a Research Agenda

• January 2005 Summit
• Future release of the toolkit
• No Research Agenda (yet) due to overriding need
  to build capacity and collect data
• Good start on a framework for a research agenda

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Quality of Care Improvements and Interventions
Implemented Based on IM Recommendations

• Review - Standards of Care
• Improve Neonatal Transport
• Comprehensive Family Practice Team Model Program
• Preconception Care Program

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Where we go from here

• Finalize and implement research agenda
• Generate FIMR and PRAMS data
• Translation to program practice
• Data linkages (internal and external)
• Evaluate care delivery programs by engaging
• Universities
• Birthing hospitals
• FQHCs
• Non-profit organizations
• Neonatologists, OBs
• Social service agencies
• Legislators
• Medicaid
• Other State Agencies
• CDC

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Thank You
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Plurality
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Plurality cont.
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Five-year Mortality Rates 24 to 27 Weeks
Gestation Delaware, 1989-2002
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