Reducing Infant Mortality Rates in Seminole County

State: FL Type: Neither Year: 2015

:
:
:
FDOH Seminole is a county in Central Florida that serves over 425,000 residents.  The infant mortality rate in 2012 exceeded the state’s infant mortality rates in all categories (overall, Whites, Blacks and Hispanics).  The state overall rate was 6.0 per 1,000 births and Seminole County was at 6.8.  Rates for Whites in Seminole County was 5.0; the Black rate was 17.1 and the Hispanic rate was 5.1.  After conducting a preliminary review of the death information, the Seminole County Healthy Start Program developed a plan to increase the marketing of the program and to provide additional outreach to specific areas of the county that had high infant mortality rates.  A county vehicle was wrapped in bright colors to draw attention to the Healthy Start Program.  The number of services provided to prenatal women increased from 69,306 to 82,950 (an increase of 13,644 units of service).  Participation in community outreach events was also increased by 59%.  As a result of the Healthy Start program’s actions, in 2013 Seminole County’s overall Infant mortality rates dropped from 6.8 in 2012 to 5.4 in 2013.  Seminole County’s overall rate is now below the state rate (6.1 in 2013).  Drops in the rate for all segments of the population occurred with the rates for Whites decreasing from 5.0 to 3.9, for Blacks from 17.1 to 14.0 and for Hispanics from 6.4 to 4.7.  The Seminole County Healthy Start program efforts resulted in six less children dying in 2013.  While the life of a child is precious and the value that a child brings to society is not easily quantifiable, based upon a NICU average cost of $3000 per day, an average 27 day NICU stay costs $81,000 per child.  Six children would cost the state of Florida’s Medicaid program $486,000. The plan resulted in a dramatic reduction in the county's infant mortality rate.  Additional reductions in both the Black and Hispanic rates are expected in 2014.
The public health issue of this project was to improve maternal and infant health.  In 2012, there were 88,505 females ages 15-44 in Seminole County and there were 4,412 infants born in 2013.  The Healthy Start Program was able to offer services to 1,635 infants or 37% of all infants born in the county and 3,943 prenatal clients or 96.8% of the prenatal clients.  Because Florida has universal screening of all prenatals and infants, the Healthy Start program only had 756 women and 492 infants with positive risk scores and an additional 1,824 women and 1,317 infants referred for other reasons. Our additional outreach efforts resulted in 1,363 additional prenatal women receiving services from our program and six less babies dying in 2013.  There had never been a structured approach to look at the data and to target specific prenatal clients in specific demographic areas.
The goal of this project was to improve maternal and child health in Seminole County.  The objectives included reducing infant mortality rates for all segments of the population.  Because Seminole County does not have a Fetal Infant Mortality Review team, detailed information about infant deaths was not available.  The Healthy Start Program pulled together a small team to look at information that we could access.  That information included: prenatal and infant Healthy Start screening data; age sex and address of infants who died in 2012; and any Healthy Start care coordination case information.  The data did not reveal any patterns of multiple births; private vs. health dept. prenatal care; extremely low birth weights; or timeliness of initiation of prenatal care.  The data did however reveal geographic areas of the county that tended to have higher numbers of infant deaths.  Because Seminole County also did not have a Healthy Start Coalition to assist with improving the system of care for women and infants, the programdeveloped a plan to increase the marketing of the program and to provide additional outreach to specific areas of the county that had high infant mortality rates.  A county vehicle was wrapped in bright colors to draw attention to the Healthy Start Program.  The vehicle was used for all outreach events, as well as visits within the community.  The number of services provided to prenatal women increased from 69,306 to 82,950 (an increase of 13,644 units of service).  Participation in community outreach events was also increased by 59%.  The first year’s goal was to reduce Seminole County’s Infant Mortality Rate to 6.0; to reduce Seminole County’s Black Infant Mortality Rate to 10.7; to reduce Seminole County’s Hispanic Infant Mortality Rate to 6.3; and to reduce Seminole County’s White Infant Mortality Rate to 4.6 by June 30, 2014.  By December 31, 2013, the targets had been met (and exceeded) for all categories except the Black Infant Mortality Rate.  Year two was to be at or below the state’s rates by June 30, 2015.  Our achieved rates by December 31, 2013 were: Overall rate of 5.4; Black infant rates of 14.0; Hispanic infant rates of 4.7; and White infant rates of 3.9. Additional stakeholders in the process included WIC, Hope Helps (a community food bank and thrift store in Oviedo) and the Grove (a substance abuse and mental health counseling center in Longwood and Sanford). Both of the community based organizations are well known within their communities and offer services at little or no cost to participants.  In addition the WIC Program offers nutritional help and vouchers to prenatal clients and their infants.  WIC and Healthy Start partner each week to offer informational classes to WIC clients.  The re-structuring of Healthy Start’s service delivery was done within the allocated budget (no additional funding).  The cost to wrap our vehicle was $2,420 and was also done within our approved operating budget by using promotional funds.
The goal of this project was to improve maternal and child health in Seminole County.  The objectives included reducing infant mortality rates for all segments of the population.  By December 31, 2013, the targets had been met (and exceeded) for all categories except the Black Infant Mortality Rate.  Year two was to be at or below the state’s rates by June 30, 2015.  Our achieved rates by December 31, 2013 were: Overall rate of 5.4; Black infant rates of 14.0; Hispanic infant rates of 4.7; and White infant rates of 3.9.  The state rates for 2013 were : Overall rate of 6.1; Black infant rates of 10.6; Hispanic infant rates of 4.4; and White infant rates of 4.6.  The number of services provided to prenatal women increased from 69,306 to 82,950 (an increase of 13,644 units of service).  Participation in community outreach events was also increased by 59%. The data is recorded in the state’s Health Management System (HMS) and reported annually on CHARTS.  As the project continued, the Healthy Start program used a Lean Six Sigma approach to redesign the front end of our system in order to engage clients earlier in Healthy Start services.  Data is reviewed monthly using Executive Summary reports from CHARTs.  The information is shared with all Healthy start staff members and adjustments to practice are made if the data indicates trending in the wrong direction.  In addition, when community outreach classes were not resulting in increased participation, the Healthy Start Program approached WIC to hold weekly instructional sessions for WIC clients.  Although this project is still in process, the change in our practice has significantly improved health outcomes in our community
Lessons learned:  Look at your data; design an approach that targets areas with significant problems; and be flexible.  We also learned that our partners can assist us in locating and delivering services to more clients than were originally referred to our program. The re-structuring of Healthy Start’s service delivery was done within the allocated budget (no additional funding).  The cost to wrap our vehicle was $2,420 and was also done within our approved operating budget by using promotional funds.  Our project is therefore sustainable and we will continue to modify our project in order to achieve our program goals.
 
Processing...


Driving Walking/Biking Public Transit  Get Directions