MICHIGAN Panel Presentation

Region V Infant Mortality Summit, Chicago, ILMarch 21, 2013

Alethia Carr, RD, MBADirector, Bureau of Family, Maternal & Child HealthMichigan Department of Community Health

Background - MICHIGAN

Population demographics <9.9 M residents in 2011

81% white, 15% black, 0.9% Native American, 2.8% Asian/Pacific Islander

8.9% Unemployment, Dec. 2012

Ranks 38th among states for IMR*Ranks 43rd for African American IMR*

Michigan’s 2010 Infant Mortality Rate (IMR) 7.1◦ African American IMR 14.1◦ American Indian IMR 10.5◦ Hispanic IMR 7.0◦ White IMR 5.5

2*Source: Kaiser State Health Facts 2006-2008

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Background - MICHIGANTheoretical Framework is:

◦Life Course Theory Timeline, Timing, Environment, Equity

◦Perinatal Period of Risk (PPOR) Examines disparities

• Governor’s Dashboard has 2 health prioritiesInfant Mortality, Obesity

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Background – MICHIGAN

Governor Snyder’s Dashboard

The infant mortality rate among Black and American Indian infants is more than twice the state rate, 3 times higher than White infants and 3.7 times higher than Asian infants

Michigan Infant Mortality RateRace Specific

Trends of Infant Mortality by Race/Ethnicity and Disparities, MI

1970-2010

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Source: Michigan Resident Birth and Death Files, MDCH Division for Vital Records & Health Statistics Prepared by: MDCH MCH Epidemiology Unit, 10/19/2012

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Background – MICHIGAN

Minority Health Bill passed in 2006 as PA 653◦Mandates the SOM “develop and implement a

structure to address racial and ethnic health disparities in this state” as part of the Public Health Code

MDCH Organizational Structure support◦Section of Health Disparity Reduction / Minority Health

Ambassador Initiative◦Overall health disparity data collection◦Epidemiology involvement◦Department wide Diversity Committee◦Health Equity Roadmap & Tool Kit created

www.michigan.gov/minorityhealth

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Infant Mortality Dashboard

Maternal & Infant Outcomes Prior

(2009) Current (2010)

Progress

Infant Mortality Rate White Black American Indian Hispanic

5.4 15.5 9.0 9.0

5.5 14.1 10.5 7.0

Low Birth Weight % White Black American Indian Hispanic

8.4 7.1 14.1 8.2 6.7

8.5 7.1 14.0 8.6 7.1

NC

<39 wks Birth % White Black American Indian Hispanic

27.9 35.3 26.9 28.6

28.9 36.5 29.1 29.3

Infant Suffocation Death Rate – MI White Black Hispanic

5.4 3.3 15.3 10.9

4.5 2.8 11.3 2.5

Infant placed to sleep on back (2006 and 2008)

White Black Hispanic

77.8% 57.2% 60.1%

75.6% 56.1% 70.8%

MI Maternal Mortality Rate White Black

28.4 22.9 49.3

41.0 31.9 77.1

Performance Key

Improvement

Decline NC No Change

Pre-/Inter-conception Health Prior

(2009) Current (2010)

Progress

Pre-pregnancy BMI >30 24.6% 25.4% Mother smoked while pregnant

18.2% 17.8%

Unintended Pregnancy 45.1% 45.2% Teen (15-17) Pregnancy Rate

25.8 23.6

Breastfeeding Rate (WIC at 6 mos.)

18.5% 17.8%

Ever Breastfed 53.5% 54.9% Chlamydia Rate 706 732

Health Care System Prior

(2009) Current (2010)

Progress

LBW infants admitted to NICU

40.0% 37.7%

NICU Central Line Infection Rate

NA 1.38

Insurance Coverage (women 18-64)

84.5%) 84.2%

1st Trimester Prenatal Care White Black American Indian Hispanic

77.3% 59.2% 67.9% 66.5%

78.0% 61.9% 68.7% 69.5%

% Need Met for Public ly- Funded Family Planning Services (2010 & 2011)

17.0% 15.0%

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State of Michigan IM Reduction Plan1. Implement Regional Perinatal

System

2. Promote statewide adoption of policies to eliminate medically unnecessary deliveries before 39 weeks gestation

3. Promote adoption of progesterone protocol for high risk women

4. Promote safer infant sleeping practices to prevent accidental suffocation

5. Expand home-visiting programs to support vulnerable women and infants

6. Support better health status of women and girls

7. Reduce unintended pregnancies

8. Weave the social determinants of health into all targeted strategies to promote reduction of racial and ethnic disparities in infant mortality

http://www.michigan.gov/documents/mdch/MichiganIMReductionPlan_UPDATED_395151_7.pdf

Key Activities - MICHIGAN State IM Reduction Plan, 2012 Perinatal System of Care Recommendations, 2009 State Innovation Model Initiative (CMS funded) PRIME – Practices to Reduce IM through Equity (WKKF funded) AMCHP Life Course Metrics National Workgroup

Participation NGA Learning Network Team Initiative CDC/AMCHP Maternal Mortality Initiative Participation AMCHP Preconception/Interconception Care Action Learning

Collaborative Participant (ALC) Michigan Primary Care Transformation Grant (CMS funded) Member of Expert Panel on Improved Birth Outcomes (CMS

sponsored) Partnership to End Disparity in IM (PEDIM) ALC (Round 2

participant) Strong Start for Mothers & Newborns Proposal Developed-not

funded

Key Activities – MICHIGANPRIME Project

The Practices for Reducing Infant Mortality through Equity (PRIME) project is funded by a grant from W.K. Kellogg Foundation

Goals include the reduction of racial disparities in infant mortality among Michigan’s ◦ African American population◦ Native American population

Focus is on institutional racism and social determinants of racial disparities

No state level data sources contained sufficient information for Native American mothers and infants◦ Michigan PRAMS randomly samples around 5-6 Native mothers each

year◦ Birth certificates contain limited information on social determinants

www.michigan.gov/dchprime 11

Successes - MICHIGAN

2012 Infant Mortality Summit & Plan2009 Perinatal Guideline RecommendationsMOD Healthy Babies are Worth the Wait effortPartnership with Michigan Hospital Association

co-sponsorship of MOD campaignStrong partnership with MOD – recent fundingExcellent collaborative partnership with Michigan

Medicaid – matching, funding, marriageStrong statewide stakeholder collaborationKellogg Foundation partnership on Equity

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Challenges – Michigan

Disparities are geographically located

Targeting efforts to greatest disparities

Provider availability◦ Rural specialty

providers limitedChanging hospital

care systemCounties with High Infant Mortality Rates in Michigan

Yellow highlights = High African American Infant Death Rates by County, 2007-2009

Blue highlights = High Caucasian Infant Death Rates by County, 2007-2009

Gogebic

Ontonagon

Houghton

Keweenaw

Iron

Baraga

Marquette

Dickinson

Alger

Delta

Menominee

Schoolcraft

Luce

ChippewaMackinac

Three-Year Moving Average Infant Death Rate, 2007-2009

Michigan Rate 7.6 per 1000

Black MI Rate 15.4 per 1000

Cheboygan

Presque IsleCharlevoix

AntrimOtsegoLeelanau

BenzieGrand

TraverseKalkaskaCrawfordOscodaAlcona

ManisteeWexford Iosco

MasonLakeOsceolaClareGladwin

Arenac

OceanaNewaygoMecostaIsabellaMidlandBay

Huron

MuskegonMontcalm

GratiotSaginaw

TuscolaSanilac

St. ClairLapeerShiawasseeClintonIoniaKentOttawa

Allegan Barry EatonInghamLivingstonOakland

Macomb

Van BurenKalamazooCalhounJacksonWashtenawWayne

Berrien HillsdaleLenaweeMonroeSt. JosephBranch

Missaukee

Alpena

Roscommon

Emmet

Genesee

Montmorency

Cass

Ogemaw

Challenges - MICHIGAN

Disparity continues and may be growing

Identifying effective methods for weaving SDOH

Metrics to demonstrate successNeed to show ROIFunding shifts and uncertaintiesKeeping all the pieces moving and

together

Wish List -MICHIGANInsight to what’s working to improve the health

of women BEFORE pregnancy and women with a history of poor pregnancy outcome

Resources for continued investment in health equity skill development for public health staff

Info about perinatal systems of care in large city communities (like Chicago, Indianapolis, Cleveland)

Methods for assuring high risk/regular OB care in rural areas

Great strategies for effective collaboration (not more meetings/better communication methods that lead to desired action)

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Team Members - MICHIGAN

Alethia CarrDebera Eggleston, MDBrenda FinkElizabeth HertelCarol LoweKarla McCandlessHolly Nickel