august 2003 perinatal periods of risk from data to action to improve women and infants’ health a...

August 2003

Perinatal Periods Of Risk

From Data to Action to Improve Women and Infants’ Health

A CityMatCH “How-to-Do” Workshop

August 2003

The “How to Do” PPOR Workshop will provide participants with the opportunity to:

1. Recognize and understand all components of the PPOR Approach

2. Assess “Analytic and Community readiness”3. Achieve a common understanding of what it takes

to conduct the first phase of analysis4. Learn how to shift focus from PPOR data to using

PPOR Approach for systems change

August 2003

Infant Mortality Rate,Urban County, 1990-2001

0

5

10

15

20

25

30

90 91 92 93 94 95 96 97 98 99 00 01

TotalWhite*Black

* White rate for 2001 is provisional

Source: DHHS

August 2003

2001 Infant Mortality Rate,Urban County vs. State

Source: DHHS

* Questionable due to small numbers

August 2003

Why Do We Need Another Way to Look at Infant

Mortality? Most current approaches do not

always identify gaps in community resources. Most current approaches do not target resources for prevention activities. Most current approaches do not use locally determined benchmarks to define disparities

August 2003

PPOR: From Data to Action

PPOR: From Data to Action

August 2003

PERINATAL PERIODS OF RISK PRACTICE COLLABORATIVE: 13 Participating U.S. Cities, 2000 - 2002

Baltimore ColumbusDurham

JacksonvilleKansas CityLouisvilleNashville

New HavenOrlando

PhiladelphiaPhoenixRaleigh

St. PetersburgPPOR-PC Partners

August 2003

PPOR – 2000-2002 Practice Collaborative

Our purpose was to determine and describe, together, the best practices in using the Perinatal Periods of Risk approach as a tool to improve maternal and infant health in communities… and, when necessary, to further develop, modify and strengthen the approach for its best use.

August 2003

Adding Adding new toolsnew tools to help solve to help solve

some very old problems some very old problems

Translating data intoTranslating data into actionaction

ChangingChanging the way we do the way we do

businessbusiness

“PPOR” is about :

August 2003

Headline News…Locally-defined disparities serve to target

further investigations and tailor preventionPhiladelphia PA

Successful integration of PPOR, FIMR, Healthy Start yields better prevention of feto-infant deaths

Louisville KY

Stronger local/state partnership builds better

data capacity to address health disparitiesColumbus OH

State-level “Practice Collaborative” model promotes consistent best uses of PPOR in

urban areasJacksonville FL

August 2003

The Value-Add of PPOR:…..from Knowing to Doing

Builds data and epi capacity Promotes effective data use Strengthens essential partnerships Fosters integration with other key efforts Localizes assessment to action process Encourages evidence-based interventions Helps leverage resources Enables systems change for perinatal health

August 2003

Perinatal Periods Of Risk… a comprehensive approach

1) Bring community partners together to build consensus, support, and partnership.

2) “Map” fetal & infant deaths by birth weight & age at death.

3) Focus on understanding the overall fetal-infant death rate.

4) Look for “opportunity gaps” between different groups.

5) Target further investigations and actions on the gaps.

6) Mobilize for sustainable systems change.

August 2003

Needs Assessment

Strategies

Plan

Implementation

Monitoring

Evaluation

Investment

Readiness

PPOR: a Tool for Planning PPOR: a Tool for Planning

August 2003

Community Foundations Cyclefor Change

Conceptual Framework for the Perinatal Periods of Risk Approach

Planning Cycle for

Action

PPOR Connections

August 2003

August 2003

6 Basic Steps: Perinatal Periods of Risk

Approach1) Bring community partners

together to build consensus, support, and partnership.

August 2003

Community Readiness:From Concepts to Tools

Partnership Leadership Commitment Change

RAISING THE ROOF FOR PPOR:What Shape Is Your Tent?

August 2003

RAISING THE ROOF FOR PPOR:

What Shape Is Your Tent?

August 2003

Louisville

June 2001 December 2002

August 2003

Community Readiness:From Concepts to ToolsRAISING THE ROOF FOR PPOR: What Shape Is Your Tent?

Tool for engaging partners Tool for reaching consensus Tool for identifying joint

assets Tool for revealing critical

gaps Tool for developing strategy

August 2003


Approach1) Bring community partners together to

build consensus, support, and partnership.


August 2003

Use linked infant birth – death file

Include fetal deaths

Building the PPOR “Map”: What data do we use?

August 2003

Fetal development is part of a continuum that runs from conception to the 1st birthday.

Fetal deaths may have similar causes as infant deaths.

The determination of “fetal” versus “infant” death is based on judgment.

Why include fetal deaths?

Including fetal deaths increases analytic power..

August 2003

PPOR Map of Fetal-Infant Mortality:

What events are not included?

Fetal deaths that occur before 24 wks Fetal deaths weighing under 500 grams

Live births weighing less than 500 grams Spontaneous and induced abortions

August 2003

Developing the “Map” of Feto-infant Mortality:

Cluster Analyses Used the 1995-1997 US fetal death and

linked birth & infant death files Clustered by both underlying cause of

death category & maternal risk factors Used near consensus findings of 8

hierarchal cluster methods: Average, Complete, Centroid, EVM, Flexible, McQuitty, Single, & Ward

Compared results to theoretical model

August 2003

Developing the “Map” of Feto-infant Mortality

<1000 g

1000-1499 g

1500-2499 g

2500+ g

Fetal Deaths

Early Neonatal

Post neonatal

Late Neonatal

1 2 3 4

5 6 7 8

9 10 11 12

13 14 15 16

August 2003

Developing the “Map” of Feto-infant Mortality

Age at Death

Birth

weig

ht

500-1499 g

1500+ g

Fetal (24 wks)

Neonatal

Postneonatal

1 2

4 5

3

6

August 2003

Perinatal Periods Of RiskFetal-Infant Mortality Map

500-1499 g

1500+ g

Fetal Death Neonatal

Post- neonatal

Maternal Health/ Prematurity

Maternal Care

Newborn Care

Infant Health

August 2003

From Data to Potential Action

Maternal Maternal Health/ Health/

PrematurityPrematurity

Maternal Maternal CareCare

Newborn Newborn CareCare

Infant Infant HealthHealth

Preconceptional Health Health Behaviors Perinatal Care

Prenatal Care High Risk Referral Obstetric Care

Perinatal Management Neonatal Care Pediatric Surgery

Sleep Position Breast Feeding Injury Prevention

August 2003

What do we mean by “PPOR Analytic

Phases”? Phase 1: Identifies the populations with overly high numbers and rates of mortality. It examines the 4 components—Maternal Health/ Prematurity, Maternal Care, Newborn Care & Infant Health—for various populations and uses a comparison group to estimate “excess deaths.”

Phase 2: Explains the excess deaths. It examines reasons for the excess deaths through further epidemiologic studies, death reviews, program and policy reviews and other community assessments.

August 2003

Examines the four “Periods of Risk” — Maternal Health/ Prematurity, Maternal Care, Newborn Care & Infant Health — for various population groups

Identifies groups and periods of risk with the most deaths, highest rates.

Uses comparison groups to estimate “excess death”

PPOR Phase 1

August 2003

Phase I Example

What are Phase I Results for Douglas County?

August 2003

PPOR Map of Fetal-Infant Deaths

Douglas County, NE, All Races1997-2000

Maternal Health/ Maternal Health/ Prematurity Prematurity

119119

Maternal Maternal Care Care

7373

Newborn Newborn Care Care

5252

Infant Infant Health Health

5454

298 Total Fetal-Infant Deaths

28,956 Fetal Deaths & Live Births

August 2003

How Do We Calculate the Fetal-Infant Mortality Rate?


August 2003

How Do We Calculate the Fetal-Infant Mortality Rate?


116 Fetal Deaths 24+ wks.

182 Infant Deaths

298 Fetal-Infant Deaths

+ 116 Fetal Deaths 24+ wks.

28,840 Live Births

28,956 Live Births & Fetal Deaths

+

/

Numerator Denominator

= 10.3 Fetal-Infant Deaths

Per 1,000 Live Births & Fetal Deaths

August 2003

Map of Fetal-Infant Mortality Rates

4.14.1

2.52.5 1.81.8 1.91.9

Fetal-Infant Mortality Rate = 298 x 1,000

28,956

= 10.310.3 (4.1 +

2.52.5 + 1.81.8 + 1.91.9)


August 2003


Approach1) Bring community partners together

to build consensus, support, and partnership.



August 2003

PPOR Map of Fetal-Infant Mortality Douglas County, Nebraska

All Races, 1990-2000

3.6

2.3 1.8 3.3

Fetal-Infant Rate=11.011.0

4.0

1.4 2.94.1

1.8 1.9

2.3

2.5



1990-1992

1993-1996

1997-2000

August 2003

White non-Hispanic Black non-Hispanic

3.53.5

2.42.4 1.51.5 1.41.4 2.72.7 4.94.93.23.2

7.17.1

White Fetal-Infant

Rate = 8.9Black Fetal-Infant

Rate =17.9

PPOR Map of Fetal-Infant Mortality Douglas County, NE,

by Race, 1997-2000

August 2003











August 2003


Approach1) Bring community partners together




4)Look for “opportunity gaps” between different groups.

August 2003

Perinatal Periods of Risk:

What is the “Gap”? ASK: Which women/infants have the "best" outcomes?

ASSUME: all infants can have similar “best” outcomes

CHOOSE: a comparison group(s) (‘reference group’) who already has achieved “best” outcomes

COMPARE: fetal-infant mortality rates in your target group with those of the comparison group(s)

CALCULATE: excess deaths (= target – comparison groups). This is your community’s “Opportunity Gap.”

August 2003

Which “Comparison Group” should we use?

Which women and infants have “best”

outcomes?

Where should the “bar”be set?

August 2003

Defined by maternal characteristics 20 or more years of age 13 or more years of education Non-Hispanic white women

12 U.S. cities with adequate reporting Low (25th percentile) group-specific

death rates

National PPOR Initiative’s “External” Comparison Group

Source: NCHS Data, 1995-1997 Calculations by CDC/CityMatCH

August 2003

2.22.2

1.51.5 1.01.0 1.21.2

Total Fetal-Infant Mortality

Rate= 5.85.8

National External Comparison Group’s

Fetal-Infant Mortality Rates

Source: NCHS Data, 1995-1997 Calculations by CDC/CityMatCH

August 2003

Map of Fetal-Infant Mortality Rates

4.14.1

2.52.5 1.81.8 1.91.9

Total Fetal-Infant Mortality

Rate = 10.310.3


August 2003

Fetal-Infant Mortality Rates Douglas County, NE vs. External

Comparison

Douglas County

Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant

Health

Fetal-Infant Mortality

Total 4.1 2.5 1.8 1.9 10.3

External Comp'so

n

Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant

Health


2.2 1.5 1.0 1.2 5.8

August 2003

ExcessExcess Fetal-Infant Mortality Rates

Douglas County, NE, 1997-2000

__

Douglas County

Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant

Health


Total 4.1 2.5 1.8 1.9 10.3

External Comp'so

n

Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant

Health


2.2 1.5 1.0 1.2 5.8

=Douglas County Excess

Mortality

Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant

Health


Total 1.9 1.1 0.9 0.7 4.54.5

August 2003

Fetal-Infant Mortality Rates Douglas County, NE, Total and by

Race, 1997-2000

August 2003

Fetal-Infant Mortality Rates Douglas County, NE, Total and by Race,

1997-2000

August 2003

Excess Fetal-Infant Mortality Rates

Douglas County, NE, 1997-2000Groups Maternal

Health/ Prematurity

Maternal Care

Newborn Care

Infant Health

Feto-Infant Mortality

Total 11..99 11..11 00..99 00..77 44..55

White Race 11..33 11..00 00..55 00..22 33..11 Non-White Race

33..55 11..33 11..77 11..88 88..22

Black Race

44..99 11..77 11..77 33..77 1122..11

External Comp’son 00 00 00 00 00

August 2003

Number of Excess Fetal-Infant Deaths


Groups Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant Health

Feto-Infant

Mortality

Total 5566 3311 2255 1199 113311

White Race 2288 2211 1111 55 6655 Non-White Race

2288 1100 1144 1144 6666

Black Race

2200

77 77 1155 4499

External Comp’son 00 00 00 00 00

August 2003

Excess Fetal-Infant Mortality using External Comparison Group

Douglas County, NE, All Races, 1997-2000Maternal Health/ Prematurity

Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

131 excess deaths

65 excess White deaths

49 excess Black deaths


August 2003


Douglas County, NE, All Races, 1997-2000

42%

24%

19%

15%

100%

0%0%0%

100%

0%0%0%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

131 excess deaths




August 2003



42%

24%

19%

15%

43%

32%

17%

8%

41%

14%

14%

31%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

131 excess deaths




August 2003











August 2003

What if we used a “Comparison Group” from within our own

community?

Which Douglas County women and infants have

“best” outcomes?

August 2003

“Internal” Douglas County Comparison Group

Defined by maternal characteristics 20 or more years of age 13 or more years of education Non-Hispanic White women Residents of Douglas County

August 2003

Number of Fetal-Infant Deaths in the Internal Comparison Group*


Maternal Health/ Maternal Health/ Prematurity Prematurity

3535

Maternal Care

32

Newborn Care

21

Infant Infant Health Health

1515


14,173 Fetal Deaths & Live Births

* applying National PPOR Definition to Douglas County data

August 2003

2.52.5

2.32.3 1.51.5 1.11.1

Total Fetal-Infant

Rate= 7.3

Fetal-Infant Mortality Rates in the Internal Comparison Group


August 2003

Fetal-Infant Mortality Rates Douglas County, NE, 1997-2000

Groups Maternal Health/

Prematurity

Maternal Care

Newborn Care

Infant Health


Total 4.1 2.5 1.8 1.9 10.3

White Race 3.5 2.4 1.5 1.4 8.9 Non-White Race

5.7 2.7 2.6 3.0 14.0

Black Race 7.1 3.2 2.7 4.9 17.9

Internal Comp’son 2.5 2.3 1.5 1.1 7.3

August 2003

Excess Fetal-Infant Mortality Rates


August 2003

Number of Excess Fetal-Infant Deaths


August 2003

Excess Fetal-Infant Mortality using Internal Comparison Group

Douglas County, NE, All Races, 1997-2000Maternal Health/ Prematurity

Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

87 excess deaths




August 2003



55%

9%

10%

26%

100%

0%0%

100%

0%0%0%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

87 excess deaths




August 2003



55%

9%

10%

26%

64%12%

24%

44%

9%11%

36%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

87 excess deaths




August 2003

Summary: Excess Fetal-Infant Mortality Rates, Using Internal and External

Comparison GroupsDouglas County, NE, 1997-2000

August 2003

Summary: Excess Fetal-Infant Deaths, Using Internal and External Comparison

GroupsDouglas County, NE, 1997-2000

August 2003

Questions? Comments? Observations?

August 2003

6 Basic Steps: Perinatal Periods of Risk Approach

1) Bring community partners together to build consensus, support, and partnership.





August 2003

What do we mean by “PPOR Analytic

Phases”? Phase 1: Identifies the populations with overly high numbers of deaths. It examines the 4 death components—Maternal Health/ Prematurity, Maternal Care, Newborn Care & Infant Health—for various populations and uses a comparison group to estimate “excess death”.

Phase 2: Explains the excess deaths. It examines reasons for the excess deaths through further epidemiologic studies, death reviews, program and policy reviews, and other community assessments.

August 2003

Phase 2: Target Investigations & Prevention

Efforts on the Gaps Shift effort and attention to the group(s)

that contributes most to the gap. Conduct further studies or mortality

reviews on the group(s) that contribute(s) to the gap - Phase 2 studies.

Examine current prevention efforts on the group(s) that contribute(s) to the gap - Phase 2 policy/program reviews.

August 2003

PPOR – Douglas CountyInitial Phase 2 Analyses

Causes of Death: Newborn Care and Infant Health

Multiple Gestation: How big is its effect on fetal-infant mortality?

Birthweight Distribution vs. Birthweight-specific Mortality: How much mortality is from the number of very small babies vs. how many babies die at a given birth weight? (“Kitagawa Analysis”)

August 2003

Phase 2: Preliminary Results


August 2003



42%

24%

19%

15%

43%

32%

17%

8%

41%

14%

14%

31%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

131 excess deaths




August 2003



55%

9%

10%

26%

64%12%

24%

44%

9%11%

36%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

87 excess deaths




August 2003

Leading Causes of Death, by Race/Ethnicity, for Combined Newborn Care and Infant Health PPOR Components, Douglas County, 1997-2000

144.0121.7

176.2

126.5107.1101.9

68.1

276.9

327.2

0

50

100

150

200

250

300

350

All White Black

Death

s per

100,0

00

Birth Defects SIDS All Other Causes

Major "other causes" include perinatal conditions, injury and infection.

August 2003

Major Causes of Death (Infants only), by PPOR Component, Douglas County, 1997-

2000 Maternal Health/ Prematurity

Newborn Care

Infant Health

Perinatal Conditions

Congenital Anomalies

SIDS

August 2003

Phase 2: Preliminary Analyses


Birthweight Distribution vs. Birthweight-specific Mortality: How much mortality is from the number of very small babies vs. how many babies die at a given birth weight once they are born?

(“Kitagawa Analysis”) Multiple Gestation: How big is its effect on fetal-

infant mortality?

August 2003


Birthweight Distribution

Birthweight Specific Mortality

Risk Factors

Interventions

Access

Socio-Economic Smoking Race Medical Conditions

Gender Gestational age Race Medical Conditions

Prenatal Care Smoking Cessation Tocolytics

Perinatal Care Quality Care Referrals

Health Insurance Primary Care Content Availability

Referral Systems Transport Systems Expertise

August 2003

A. Total Excess (All Birthweight Categories)

39.5%

60.5%

Birthweight Mortality67.0%

33.0%

Birthweight Mortality

B. Maternal Health/ Prematurity Excess

Kitagawa AnalysisDouglas County, 1997-2000

August 2003

Phase 2: Preliminary Analyses


Birthweight Distribution vs. Birthweight-specific Mortality: How much mortality is from the number of very small babies vs. how many babies die at a given birth weight once they are born? (“Kitagawa Analysis”)

Multiple Gestation: How big is its effect on fetal-infant mortality?

August 2003

Examining the Impact of Multiple Gestations in Douglas County,

Nebraska1. What is the prevalence of multiple

gestations in Douglas County?

2. What is the prevalence of multiple gestations by race/ethnicity, and over time?

3. What is the mortality experience for multiple gestations?

4. How much of overall fetal-infant mortality is explained by multiple gestations?

August 2003

Prevalence of Multiple Gestations

among Fetal Deaths and Live Births

**The percentage of multiple gestations is significantly higher in Douglas County than in the US and in Midwest Cities, although the significance between Douglas County and Midwest Cities decreases after adjusting for maternal race, age and education.

* Midwest Cities are Kansas City, Wichita, St. Louis, Toledo and Cincinnati.

August 2003







August 2003

Prevalence of Multiple Gestations,Douglas County, NE, 1990 - 2000

1990-1992

1997-2000

% Multiple Gestation Births

*The increase in multiple gestations over the three time periods is significant.

1993-1996

August 2003





3. What is the mortality experience for multiple gestations in Douglas County?


August 2003

Fetal-Infant Mortality Rates for Single Gestations, Douglas County and the

U.S.

*Midwestern cities are the only significant difference with Douglas County (11.2/100,000 vs. 9.4/100,000).

August 2003

Fetal-Infant Mortality Rates for Multiple Gestations, Douglas County and the

U.S.

•There are no significant differences for comparisons with Douglas County.

•There are too few non-White multiple gestations to give stable rates.

August 2003

Summary: Plurality-Specific Fetal-Infant Mortality Rates

Mortality rates for single gestations are significantly lower in Douglas County than in selected Midwestern cities. There are no significant differences in mortality rates for multiple gestations in Douglas County compared to the U.S. and selected Midwestern cities.

August 2003







August 2003

A Different Way to Look at the Question: Population Attributable

Risk

Population Attributable Risk (PAR)

= risk population - risk unexposed

PAR measures the amount by which the overall frequency of the disease in the population would be reduced, if the exposure of interest were removed.

“What is the effect of the exposure on the overall population ?”

August 2003

Population Attributable Risk for Multiple Gestations, Douglas

County and Midwest Cities

Douglas County

Midwest cities

Population Attributable Risk

•Midwest cities data are from 97-98. Douglas County data are from 1997-2000.

August 2003



Birthweight Specific Mortality

Risk Factors

Interventions

Access

Socio-Economic Smoking Race Medical Conditions

Gender Gestational age Race Medical Conditions

Prenatal Care Smoking Cessation Tocolytics

Perinatal Care Quality Care Referrals

Health Insurance Primary Care Content Availability

Referral Systems Transport Systems Expertise

How much mortality is from the number of very small babies vs. how many babies die at a given birth weight once they are born? (“Kitagawa Analysis”)

August 2003

A. Maternal Health/ Prematurity Excess Compared to External Comparison

67%

33%

66%

34%

Kitagawa Analysis: All RacesDouglas County, 1997-2000

B. Maternal Health/ Prematurity Excess Compared to Internal Comparison


Birthweight-Specific Mortality

Birthweight Distribution vs. Birthweight-specific Mortality: How much mortality is from the number of very small babies vs. how many babies die at a given birth weight once they are born?

August 2003

A. Maternal Health/ Prematurity White Mothers

62%

38%

83%

17%

Kitagawa Analysis: By RaceDouglas County, 1997-2000External Comparison Group

B. Maternal Health/ Prematurity Black Mothers


Birthweight-Specific Mortality

August 2003

Douglas County Feto-Infant Mortality Rates by PPOR Component, 1990-2001

0

1

2

3

4

5

6

90-93 91-94 92-95 93-96 94-97 95-98 96-99 97-00 98-01

Rate

Per

1,0

00

MH

MC

NC

IH

August 2003

Douglas County Feto-Infant Mortality Rates by PPOR Component - White, 1990-2001

0

1

2

3

4

5

6

90-93 91-94 92-95 93-96 94-97 95-98 96-99 97-00 98-01

MH

MC

NC

IH

August 2003

Douglas County Feto-Infant Mortality Rates by PPOR Component - Black, 1990-2001

0

1

2

3

4

5

6

7

8

9

10

90-93 91-94 92-95 93-96 94-97 95-98 96-99 97-00 98-01

Rate

Per

1,0

00

MH

MC

NC

IH

August 2003

Excess Fetal-Infant Mortality using External Comparison GroupDouglas County, NE, All Races, 1997-2000

42%

24%

19%

15%

43%

32%

17%

8%

41%

14%

14%

31%


Maternal Care

Newborn Care

Infant Health

Total

Whites Blacks

131 excess deaths




August 2003

Philadelphia’s PPOR

Phase 2 Analysis: Combine PPOR methodology with Geographical Information Systems (GIS).Benefits: 1) Provides information for fine tuning existing programs. 2) Provides information on where new programs are needed.3) Provides information for specific communities4) Serves as a tool for epidemiological investigations

August 2003

Infant Mortality 1998-2000 Density Analysis

West Oak Lane

HS West/SW

HS North

August 2003

Philadelphia PPOR Summary

PPOR analysis is starting point not the ending point

Provides a framework for discussing the problem

Provides a framework for further investigation of the problem

August 2003

Louisville’s Lessons Learned

Improve existing data and/or develop other data sets as necessary: better data for better information

PPOR integration into the existing community initiatives enhanced the MCH/women’s health capacity/efforts

Be flexible, adjust the system by using the evidence-based findings

Need right stakeholders and political will to be successful

Work as a team, build partnership and collaboration

August 2003

RecommendationsRecommendations

PPOR Phase 1Link births with deaths

Identify the groups with gaps

FIMRHome interviews + medical records

PPOR Phase 2Vital Statistics data

Data + stories(paint faces behind the numbers)

Identify problems/gaps in services

Statistical data analysis Analyze the impact of different

risk factors

Develop evidence-based prevention strategies (preconceptional, during pregnancy and interconceptional) e.g. Healthy Start

Develop evidence-based prevention strategies (preconceptional, during pregnancy and interconceptional) e.g. Healthy Start

Improve women and children’s health

Reduce the existing racial disparities

Improve women and children’s health

Reduce the existing racial disparities

MCH Initiative : “Healthy women, children and families”

August 2003

Perinatal Periods Of Risk Approach

…not just data.1) Bring community partners together






6) Mobilize for sustainable systems change.

August 2003

Perinatal Periods of Risk: For More Information: www.citymatch.org

august 2003 perinatal periods of risk from data to action to improve women and infants’ health a...

Documents

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ppor approach

ppor workshop

infant health

doingbuilds data

dhhs2001 infant mortality

community resources

better data capacity