Perinatal Periods of Risk: A Community Approach for Using Data to Improve Women and Infants’ Health

Peck, Magda G.; Sappenfield, William M.; Skala, Jennifer

doi:10.1007/s10995-010-0626-3

Cited by 27 publications

(13 citation statements)

References 11 publications

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“…Before any restrictions, there were 174,558 records in the live birth file. Live birth records were excluded from the analysis if (1) they were missing birth weight data (36 or 0.02%), (2) birth weight was less than 500 grams (585; 0.34%), (3) race/ethnicity was not black or white, non-Hispanic (14,347 or 8.2%), and (4) they were implausible gestational age and birth weight combinations (119 or .07%), per PPOR analytic guidelines [5, 15]. After all exclusion criteria were applied, the final live birth file had 159,547 live birth records.…”

Section: Methodsmentioning

confidence: 99%

Very Low Birth Weight and Perinatal Periods of Risk: Disparities in St. Louis

Xaverius

Salas

Kiel

et al. 2014

BioMed Research International

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Objective. Very low birth weight (VLBW) is a significant issue in St. Louis, Missouri. Our study evaluated risk factors associated with VLBW in this predominantly urban community. Methods. From 2000 to 2009, birth and fetal death certificates were evaluated (n = 160, 189), and mortality rates were calculated for perinatal periods of risk. The Kitagawa method was used to explore fetoinfant mortality rates (FIMR) in terms of birth weight distribution and birthweight specific mortality. Multivariable logistic regression was used to assess the magnitude of association of selected risk factors with VLBW. Results. VLBW contributes to 50% of the excess FIMR in St. Louis City and County. The highest proportion of VLBW can be attributed to black maternal race (40.6%) in St. Louis City, inadequate prenatal care (19.8%), and gestational hypertension (12.0%) among black women. Medicaid was found to have a protective effect for VLBW among black women (population attributable risk (PAR) = −14.5). Discussion. Interventions targeting the health of women before and during conception may be most successful at reducing the disparities in VLBW in this population. Interventions geared towards smoking cessation and improvements in Medicaid and prenatal care access for black mothers and St. Louis City residents can greatly reduce VLBW rates.

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Section: Methodsmentioning

confidence: 99%

Very Low Birth Weight and Perinatal Periods of Risk: Disparities in St. Louis

Xaverius

Salas

Kiel

et al. 2014

BioMed Research International

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“…Disparities remain unacceptably high, particularly in the areas of prematurity and infant mortality. 3 There is a great need for effective interventions, financing, and delivery systems that address a continuum of needs among women before, during, and after pregnancy as well as to both newborns and older infants. To catalyze the alignment, the Centers for Medicare and Medicaid Services convened an Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program.…”

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confidence: 99%

Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program

Applegate

Gee

Martin

2014

Obstetrics &Amp; Gynecology

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Maternal and infant health is critical to our nation's health. Disparities remain unacceptably high, particularly in the areas of prematurity and infant mortality. In 2012, traditionally distant partners such as federal and state governments, Medicaid and commercial payers, patients, public health and private clinicians, and multiple advocacy groups collaborated to focus on improving birth outcomes. To catalyze the alignment, the Centers for Medicare and Medicaid Services convened an Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program. Over a year's time, the Expert Panel assimilated the best available evidence in clinical science and policy from content leaders and patients. These recommendations culminated in the present report, which challenges us as a nation to implement strategies to help all children have the best chance to survive and thrive comparable to that of other westernized nations.

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“…Third, the action statements can be used to further the work of the Perinatal Periods of Risk (PPOR) approach [53][54][55][56]. PPOR, a comprehensive approach to help communities use data to reduce infant mortality, was designed for use in urban areas with high infant mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

Kasehagen¹,

Brandert²,

Nickol³

et al. 2014

J. Racial and Ethnic Health Disparities

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Objectives This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). Design Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. Results Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services -014-0008-4 for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. Conclusion Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or systemwide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.. Racial and Ethnic Health Disparities (2014) 1:69-84 DOI 10.1007/s40615

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Perinatal Periods of Risk: A Community Approach for Using Data to Improve Women and Infants’ Health

Cited by 27 publications

References 11 publications

Very Low Birth Weight and Perinatal Periods of Risk: Disparities in St. Louis

Very Low Birth Weight and Perinatal Periods of Risk: Disparities in St. Louis

Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

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