Juanita Graham MSN RNHealth Services Chief Nurse

MS State Dept of Health

The MIME & DIME Projects:Serving high risk mothers of very low birthweight infants

White Black Total0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

7.0

13.6

10.0

Infant mortality by race, MS 2009P

er

1,0

00

live

birt

hs

61.60%

38.00%

Infant mortality by age at death, MS 2009

Neonatal

Postneonatal

VLBW (<1500g)

LBW (1500g - 2499g)15%

NBW (≥

2500g)29%

VLBW (< 1500g)

56%

% of infant deaths by birthweight, MS 2009

17%

83%

% of infant deaths by maternal age, MS 2009

≤ 19 yrs 20+ yrs

<18 yrs18 - 24 yrs

25-34 yrs35+ yrs

0

2

4

6

8

10

12

14

16

5.88.7

4.8

10.6

8.1

12.8

15.5 15.2

Infant mortality by race & age of mother, MS 2009

White Black

Retrospective cohort study using linked birth & death certificate files for MS infants, 1996-2003 (n=341,780).

A population of (n=297,418) non-Hispanic white & black singleton live-born infants studied

Assessing relationship between chronic conditions and IM, LBW, PTB

Findings from Linked Data

Findings from Linked Data

Poorest outcomes among:Black mothersBlack IM rates increased w/

maternal age< HS educationSingleNo prenatal care

Findings from Linked Data

Maternal medical history:

Maternal Medical History PTB LBW Infant Death

  OR (95% CI) OR (95% CI) OR (95% CI)

Previous infant <2500g vs. previous infant ≥ 2500g 3.5 (3.3-3.8) 4.6 (4.3-5.0) 3.0 (2.4-3.7)

Diabetes vs. No diabetes 1.2 (1.1-1.3) 0.8 (0.7-0.9) 1.4 (1.1-1.7)Hydramnios / oligohydramnios vs. Neither condition 1.8 (1.7-2.0) 3.1 (2.8-3.4) 4.4 (3.63-5.3)

Hypertension vs. No hypertension 2.1 (2.0-2.2) 3.2 (3.1-3.4) 1.2 (1.0-1.4)

Problem: Many Mississippi babies die very small & very young despite prenatal care

Hypothesis: Mississippi women are not healthy enough to achieve a full term, normal weight delivery

Solution: Intervention PRIOR to conception

Method: IPC for small population with highest risk for poor delivery outcomes

What to do? What to do?

Preconception / interconception care pilot programs

Rural vs. Urban communitiesDelta Infant Mortality EliminationMetro Infant Mortality Elimination

MIME & DIME

Mississippi State Department of Health – lead agency

University of MS Medical Center – principal recruitment site & service provider.

Healthy Linkages – referral service for identification of medical homes.

Division of Medicaid – data source.

Partnering organizations

Federally qualified community health centers – primary care medical homes.

World Health Organization Collaborating Center for Reproductive Health – technical assistance.

Partnering organizations

Individualized interpregnancy care plan based on assessments of medical/ social risks for subsequent poor pregnancy outcomes

Provision of primary health care & dental services in accordance with care plan for 24 months

IPC intervention package

Assistance in achieving woman’s desire for subsequent pregnancies & need for optimum child spacing (ideally 18-20 months);

Provision of appropriate social services & community outreach in each woman’s community.

IPC intervention package

Expansive, rural geographical areaTransportationLimited resourcesLimited funding

Problems & lessons learned

On-going surveillance combined with comprehensive evaluation at the project’s end

Health, reproductive and economic outcomes to be evaluated

Cost-benefit analysis to compare cost savings to costs of program

Project evaluation

Goal: Funding to support statewide expansion of program

Format: Medicaid waiver; other internal options include focusing on increased enrollment and participation in reimbursable programs that could sustain the program

Goal