Reducing Infant Mortality Rates Across the Country
In 2014, a baby born in the United States was more than twice as likely to die in its first year of life than a baby born in the Czech Republic, Finland, Japan, Portugal or Sweden. These nations are joined by over 25 others who have lower infant mortality rates (IMR) than the United States. Significant racial inequities accompany these staggering figures, with non-Hispanic black babies twice as likely to die compared to white babies in their first year of life in the U.S. If these rates remained unchanged, over 23,000 babies would continue to die annually.
NICHQ addressed the challenge of infant mortality by leveraging a unique methodology that combined quality improvement (QI), innovation and collaborative learning. To effectively unite the 51-participating state and jurisdiction teams around a common goal, we used a collective impact framework where NICHQ served as the backbone organization alongside HRSA MCHB, providing resources and facilitating coordination. Three core methods—the Breakthrough Series, the Model for Improvement and Collaborative Innovation Networks—helped teams test change and collaborate around shared interests.
Following an iterative process, six strategy areas were identified: safe sleep; smoking cessation; prevention of preterm and early term births; preconception and interconception care; risk-appropriate perinatal care; and social determinants of health. NICHQ recommended that each state focus on at least one but no more than three of the six areas. Along with providing technical QI assistance, NICHQ led communication efforts by developing an online community and shared data infrastructure.
- A national decline of 5 percent in IMR (helping reduce what would have been an additional 1,775 infant deaths)
- 81 percent of states demonstrating a decline in their IMR across all infants born
- 29 percent of the states showing a 10 percent or greater decline in IMR
- States/jurisdictions achieving a 5 percent reduction in neonatal mortality rate and postneonatal mortality rate
- States/jurisdictions achieving a 6 percent reduction in preterm related mortality rate
- States/jurisdictions achieving a 3 percent reduction in preterm birth rate
- The creation of an interactive infant mortality prevention toolkit featuring change ideas, case studies, videos and key insights, insures that the learning and action can continue even when the official project ended. Get started.
- An expert webinar series where participants walked away with actionable insights that contribute to the goal of every child reaching his or her first birthday and beyond. Find recordings here.
Without the 5 percent decline in IMR, 87 kindergarten classrooms would have been empty in 2015. The initiative’s success presents a much-needed model for tackling national population based health efforts. The project was also successful in opening up lines of communication between state health departments and state Medicaid offices to better support data sharing and influence new reimbursement policies for maternal and infant health.
Also now with the scaffolding in place—including shared goals and an understanding of how to use QI methods to make successful systems change, as well an accessible date infrastructure that impacts programming in real-time—state health departments and communities around the country can better address the complex systemic challenges related to infant mortality. Through enhanced cross-sector collaboration, they can work towards eliminating the racial and ethnic birth outcome disparities that still persist to ensure that all infants born in the United States reach their first birthday.
Essentials of Collaboration
This interactive course explores how to produce positive population health outcomes through effective collaboration. With directions on breaking down silos, aligning activities, and working productively together, this course provides a foundation for partnering with others to make a difference in your community.
Quality Improvement 101
This interactive course teaches the fundamentals of quality improvement (QI) and how to use this methodology to create effective, beneficial change. Lessons and exercises go over important elements such as the Model for Improvement, Plan-Do-Study-Act cycles, implementation and spread.
Quality Improvement 102
This interactive course provides further insight into the quality improvement best practices needed to create effective change. The course reviews the concepts covered in Quality Improvement 101, and then gives direction on how to test improvement ideas and increase their impact and effectiveness. Lessons and exercises provide examples of best practices and offer direction on moving from one PDSA cycle to another.
Infant Mortality CoIIN Prevention Toolkit
This interactive toolkit allows users to learn from participants in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN). Organized by topics from the initiative, this toolkit features change ideas, case studies, videos and key insights from teams who are working to reduce infant mortality throughout the country.
Seeking Quality Improvement through a Racial Equity Approach
In the U.S., the gap in health outcomes between non-Hispanic black and non-Hispanic white children continues to widen, with children of color more frequently suffering from chronic and preventable health conditions. Incorporating both a health and racial equity lens can help us drive sustainable improvements and counteract the role racism plays as key determinant of health. Here are four pieces of advice for applying that lens.
9 Tips for Moving from One PDSA Cycle to the Next
After finishing your first PDSA cycle, you're ready to dive into the next phase of continuous improvement: your second, third and fourth PDSA cycle, or, as many cycles as needed to reach the final adoption stage. Here are nine rules to help you double check and develop your next round of predictions.
Closing the Breastfeeding Disparity Gap: Methods for Improvement
When compared to all other racial groups, Hispanic mothers are most likely to supplement breastmilk with formula within the first two days of life. One hospital on the Texas-Mexico border, serving a nearly 100 percent Hispanic population, has introduced a variety of interventions aimed at closing the breastfeeding disparity gap, specifically as it relates to exclusive breastfeeding.
A Proactive Approach to Early Children’s Vision Screening
As part of the Improving Children’s Vision: Systems, Stakeholders & Support (ICV) initiative, NICHQ is helping three states to develop comprehensive, coordinated approaches to improving vision and eye health for children under age 5. Introducing a systems-level approach can best overcome geographic and economic obstacles, and navigate the various components of state and community health systems.
What Comes First? The Policy or the Change?
What happens if the process to introduce new policies impedes or delays the provision of higher quality, evidence-based care, such as new infant safety recommendations or a proposal for improved epilepsy diagnosis? In other words, what happens if policy becomes a barrier to change rather than a core driver?
How to Cope with Change Fatigue
To keep your change initiative moving forward on the right path it’s important to know the symptoms of fatigue and the right strategies for addressing them. To help, we’ve paired the common causes of change fatigue with proven strategies to keep your change efforts on track.