Reducing Infant Mortality Rates Across the Country
In 2014, babies born in the United States were more than twice as likely to die in their first year of life than a baby born in the Czech Republic, Finland, Japan, Portugal or Sweden. In total, 23 nations have lower infant mortality rates (IMR) than the United States. Significant racial inequities accompany these staggering figures, with non-Hispanic black babies more than 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 demonstrated a decline in their IMR
- Almost a third of states/jurisdictions showed a 10 percent or greater decline in their IMR
- States/jurisdictions achieved a 6 percent reduction in the preterm-related mortality rate (number of deaths of preterm babies)
- States/jurisdictions achieved a 5 percent reduction in the neonatal mortality rate (number of deaths during the first 28 days of life) and the postneonatal mortality rate (number of deaths between 28 and 364 days of life)
- States/jurisdictions achieved a 3 percent reduction in the preterm birth rate (number of preterm babies, i.e. those born before 27 weeks of pregnancy are completed)
- Created a measurement framework and indicator set for social determinants of health by gathering and synthesizing 345 national and state measures
- 14 of 19 state teams participating in the social determinants of health learning network showed improvement in their knowledge and capacity to define, discuss, and advance strategies to address social determinants of health.
- 73 percent of states/jurisdictions reported feeling equipped to collaborate with other teams for improvement
- Over 7,000 users utilized the NICHQ Infant Mortality CoIIN Collaboratory, a virtual place for collaboration, and shared nearly 14,000 resources
- 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 data 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.
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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.
Recognizing Implicit Bias Can Reduce Inequities in Children’s Health
Here, Joseph R. Betancourt, MD, MPH—a nationally and internationally recognized expert in healthcare disparities, cross-cultural health and cross-cultural communication—shares recommendations to help health professionals and improvement teams better identify bias and prevent it from affecting their behaviors and decisions.
An African-American Fraternity Alliance is Changing Infant Health Outcomes
In Arkansas, nearly 300 babies die before their first birthday each year. That’s almost a baby every day. Determined to change these numbers and reach communities most affected, the Arkansas Department of Health turned to a nontraditional partner for maternal and infant health: Brothers United, an alliance of African American fraternities.
The Opioid Epidemic and Maternal Health: Three Opportunities for Change
Opioid use disorder in pregnancy has increased dramatically across the country in the last decade, bringing with it increased health risks for mothers and babies. Health professionals can help change these statistics by making the most of every interaction they have with new mothers, from prenatal care to building postpartum supports. Click in for advice from experts in the field.
Keeping Families Together Improves Children’s Health Outcomes, from Borders to Communities
Thousands of children were recently separated from their families on the Texas border. Too many children have undergone the trauma of preventable family separation, which cannot be undone. NICHQ's new Chief Health Officer, Elizabeth Coté, MD, MPA, has witnessed the devastating effects of caregiver-child separation in communities across the country and across the world. In this article, she speaks up about the harm of that separation and urges us to remain vigilant about keeping families together.
Case Study: Engagement of Title V, Healthy Start and Families to Increase New Mother Wellness in NJ
A new issue brief, co-authored by AMCHP and NICHQ, explores how New Jersey engaged mothers in its efforts to improve postpartum visit rates as a strategy to increase new mother wellness.
Building Resiliency in Teen Moms Can Improve Breastfeeding and Save Babies
Less than one in five adolescent mothers exclusively breastfeeds their babies for the recommended six months. This means that, with the right supports, over 80 percent more teen moms and their babies can gain proven health benefits, including a reduced risk of sudden infant death syndrome. Here, Lori Feldman-Winter, MD, MPH, highlights strategies that uniquely empower teen mothers to breastfeed their babies.