using ppor to address low birthweight bill ulmer, mph, ma director, community health...

Using PPOR to Address Low Birthweight

Bill Ulmer, MPH, MA

Director, Community Health

Chattanooga-Hamilton County Health Department

Where in the world isChattanooga, TN?!

Hamilton Co: Urban and Rural Mix

Regional Health Plan 2002 Infant Mortality Rate: 9.8

Black rate 15.0White rate 7.1

Low birth weight 11.4% of all live births.Blacks 16.4%Whites 8.8%

For each race, LBW HIGHER than US, TN, or any other metropolitan area in TN

Organizational Developments In November of 2002, the Regional Health

Council made infant health a top priority and appointed a Task Force.

By January of 2003, the Task Force had organized under the leadership of Dave Adair, M.D., and selected the PPOR approach.

In March, the Task Force set a goal to reduce LBW births to 8.4% of live births by 2007.

PPOR Findings

Overall Excess Mortality in Hamilton County:

7.2

 Maternal Health/ Prematurity: 3.3

Maternal Care: 0.7

 Newborn Care: 1.0

Infant Health: 1.9

13.0 Fetal-Infant Deaths Per 1000 Live Births + Fetal Deaths

Due to rounding, numbers do not add to totals.

Maternal Health/ Prematurity

5.5Maternal

Care2.2

Newborn Care2.0

Infant Health

3.1

So… time for action?!

First… A Message from our Sponsor

A Framework for Assessing Community Readiness Change is inherent in the PPOR approach. 5 components for community readiness for change:

ReasoningRolesResourcesRisks/RewardsResults

Assessment of Community Readiness

PPOR Guidelines suggest conducting an internal assessment every six months.

A tool for assessing the five components of community readiness for change is provided.

The assessment instrument was easily modified to fit the needs of the Low Birth Weight Birth Task Force.

Modifying the Assessment ToolWe revised the

very important 3 page assessment instrument.

For example: From: We can

communicate a clear, compelling case for doing PPOR at this time…

To: We can communicate a clear, compelling case for the work of the Task Force…

FINDINGS - Reasoning: Score 5 The first assessment was

conducted at the May meeting of the Task Force.

Under the first item, Reasoning, The Task Force felt very confident about the Task Force’s underlying rationale.

Results: Score 4 There was discussion about the

role of the Task Force: a planning body with no real authority to implement the strategies. The need to move from a very general goal to more specific objectives was discussed. Whether the Task Force has enough Prevention expertise to get the desired results was also questioned.

Roles: Score 3 Many felt that this may be

the most difficult item. In particular, involving sponsors and targets, and developing their buy-in and championing of the work, seemed problematic. Politics and funding concerns were raised.

Risks and Rewards: Score 3 A lack of understanding,

among everyone from parents to policy makers, of the health and economic consequences of low birth weight births and of the rewards to the community if this problem can be curtailed, was identified.

Resources: Score 4 It was thought that the

community does have the resources to reduce low birth weight births.

Recent questions about existing services suggest the need for asset mapping.

Reasoning

Roles

Resources

Risk/Rewards

Results1 5432

5

4

3

2

5

4

3

2

5

4

3

2

5 4 3 2

Not Quite Organized for Success!

Take Home Lessons Prevention expertise is needed Bringing all the players to the table is difficult Asset mapping may be necessary and might begin early in

the process. Take time to make the case to the community about the

importance of the work. Moving from lack of awareness or defensiveness to

“ownership” is challenging. Reducing LBWB’s is everyone’s problem.

Recent Developments Consumer Advisory

Group (recently organized, no existing group in the county.)

Newsletter (sent in draft form to physicians)

Input from ‘similar’ communities (Aiken, SC; Nashville, TN)

We’ve got the skills…

The PPOR approach brings:

Analytic Confidence

Organizational Ability