Secretary’s Advisory Committee on Infant Mortality

November 14, 2012

David Lakey, M.D.Commissioner

Texas Department of State Health Services

Maternal Care

Newborn Care

Infant Health

Maternal Health/

Prematurity

Preconception Health Health Behaviors

Perinatal Care

Prenatal Care High Risk Referral

Obstetric Care

Perinatal Management Neonatal Care

Pediatric Surgery

Safe Sleep Breast Feeding Injury Prevention

2

Possible Points for Intervention

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9

23

15

41

23

0

10

20

30

40

50

Wei

gh

ted

%

White Black Hispanic

19902010

Adult Obesity in Texas(1990 vs. 2010)

3

Texas Women Fail to Meet Healthy People 2020 Prenatal Care Goal

2005 2006 2007 2008 2009 20100.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

64.0 61.5

59.6 59.1 59.1 64.7

Percent of Mothers Who Received Prenatal Care in the First TrimesterTexas 2005-2010

TX Healthy People 2020 Goal (77.9%)

Year

Per

cen

t o

f L

ive

Bir

ths

4

Almost Half of Black Women in Texas –No First Trimester Prenatal Care

All Race/Ethnicities White Black Hispanic Other0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

64.7

72.7

54.160.9

68.8

Percent of Mothers Who Received Prenatal Care in the First Trimester of Pregnancy by Race/Ethnicity, Texas 2010

Received PNC in 1st Trimester Healthy People 2020 Goal (77.9%)

Race/Ethnicity

Per

cen

t o

f L

ive

Bir

ths

5

Inductions Have Increased Steadily in Texas and the US

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20104.0

9.0

14.0

19.0

24.0

29.0

18.4

25.8

19.9

23.4999999999999

Induction Births, Texas and U.S., 2000-2010

TX United StatesYear

Per

cen

t o

f L

ive

Bir

ths

6

Elective Inductions Increase Prematurity and C-Section Rates

• In 2010, 1 in 4 deliveries were induced in Texas

• Induction rates increased by 40% in Texas between 2000-2010

• In 2010, 38.4% of single-birth inductions were performed before 39 weeks of gestation

• Labor induction is associated with an increased risk of delivery by cesarean section (C-section) 7

Preventing Infant Mortality through Regionalization of Perinatal Services

• Very low birth weight (VLBW) infants – Represent less than 2% of US births– Account for 55% of infant deaths

• Levels of perinatal care (I, II, & III)– Level III facilities have the ability to care for very low birth

weight infants.– VLBW infants not born in a level III hospital are more likely

to die.

• HP 2010 goal: 90% of all VLBW infants are born in level III hospitals– Only met by 5 states– 10 states (including TX) are below 70%

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Healthy Texas Babies

• Healthy Texas Babies (HTB) is an initiative to decrease infant mortality in Texas

• Goals of Healthy Texas Babies Initiative:

– Provide local partnerships and coalitions with major roles in shaping programs in their communities

– Use evidence-based interventions– Decrease preterm birth rate by 8% over 2 years– Save ~ $7.2 million in Medicaid costs over 2 years

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• Legislation to eliminate Medicaid payment for elective inductions/C-sections <39 weeks

• Outreach campaign to promote father’s involvement with children before birth

• Council created to study neonatal intensive care unit regionalization

• $4.1 million General Revenue appropriated for this effort

Healthy Texas Babies

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HTB Local Coalitions

Eleven Local Coalitions Evidence-based

projects Broad-based

Membership December 2011-

August 2013 $200K contracts

awarded to each of the 11 local coalitions

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DSHS Local Coalition Initiatives

• Corpus Christi – Preconception Diabetes Management

• Dallas – Feto-Infant Mortality Review Board

• El Paso – Enhanced identification of high-risk pregnancies

• Fort Worth – Fatherhood Mentoring for Teen Dads

• Galveston – Mother-Friendly Worksite – Breastfeeding

• Houston – Pre- and Inter-conception Wellness

• Laredo – Media Campaign on Perinatal Health

• Longview – Centering Pregnancy ®

• Lubbock – Stork’s Nest®

• San Antonio – HOPES Project: Case Management for Mothers with Previous Poor Birth Outcomes

• Waco – Healthy Babies are Worth the Wait®

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“Someday Starts Now”

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“Someday Starts Now”

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“Protect Two From the Flu”

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16

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2009 2010 2011 2012

Year

Texas Pre-Term Birth Rates

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

White 11.5 11.8 12.1 12.7 12.8 12.9 12.5 12.5 12.2 11.8 11.8 11.1776262567896

11.0754174799393

Black 17.3 18 18 19 18.5 18.8 18.5 18.2 17.4 17.6 17.7 16.746604615

823

16.399834093

737

Hispanic 12.3 12.6 13.1 13.5 13.2 13.3 13.4 13.5 13.2 13 13.3 13.2450404954209

12.7529055078322

Other 11.7 11.4 11.3 11.7 11.2 11.6 11.7 11.5 11.2 11.4 12 11.4193346542914

10.949410949

411

Texas 12.6 12.9 13.2 13.7 13.6 13.7 13.6 13.6 13.2 13 13.3 12.8242985003725

12.4810442460889

1.03.05.07.09.0

11.013.015.017.019.0

White Black Hispanic Other Texas

Preliminary & Par-tial Year Data

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ASTHO Presidents Challenge 2012: Healthy Babies

Goal:  Improve birth outcomes by reducing infant mortality and prematurity in the United States.

Overall Objectives: 

1. Focus on improving birth outcomes as SHOs and state leadership teams work with state partners on health and community system changes.

2. Create a unified message that builds on the best practices from around the nation and the efforts from Regions IV and VI, which can be adopted by states, U.S. territories, and the District of Columbia.

3. Develop clear measurements to evaluate targeted outreach, progress, and return on investment.

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ASTHO President’s ChallengePledge to Reduce Prematurity by 8% by 2014

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State Strategies to Improve Birth Outcomes

• Reduce early elective deliveries <39 weeks

• Access topreconception/interconception care

• Smoking cessation• Preventing SIDS• Improve perinatal

regionalization• Expand access to 17-P

Reduce Elective Deliveries <39 Weeks

• Louisiana – Louisiana Birth Outcomes Initiative

• Texas – House Bill 1983

• West Virginia – Universal Maternal Risk Screening Program

• Indiana – 40 Weeks of Pregnancy, Every Week Counts Provider Toolkit

• Kentucky- Healthy Babies are Worth the Wait

Oklahoma - Every Week Counts

• Began recruiting hospitals for voluntary “hard stop” effort in January 2011

• Currently have 52 of 59 birthing hospitals enrolled (88%)

• Have seen 70% reduction in rate of induction <39 weeks without medical indication

24%

70%

7.2%

• Georgia – expanded Section 1115 Medicaid waiver

• Oregon – Innovative Reproductive Health Program combines Title X and Medicaid family planning waiver programs

• South Carolina – Campaign to Prevent Teen Pregnancy website

• California – The Interconception Care Project

Access to Preconception, Interconception Care

• Colorado – Colorado QuitLine, a free program for pregnant women

• Oklahoma – practice facilitation model in obstetric care settings; SoonerQuit statewide media campaign

• North Carolina – You Quit Two Quit Project

• Massachusetts – QuitWorks referral program

• Michigan – free quitline counseling for uninsured or Medicaid enrollees

Smoking Cessation

• Georgia – Crib Matching Program through SIDS Injury Prevention Program

• Maryland – B’more Babies Safe Sleep Campaign

Preventing SIDS

• New York – Regional Perinatal Center (RPC) leads and coordinates affiliated hospitals

• Tennessee – Perinatal Advisory Committee; five statewide centers provide 24-hour consultation and referral

Improve Perinatal Regionalization

• North Carolina – 17-P is part of the Pregnancy Medical Home program

• Louisiana – 17-P Louisiana Resource Center

Expand Access to 17-Hydroxyprogesterone (17-P)

Thank You!

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