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.
Addressing Black Maternal Mortality Rates Starts with Listening to Black Women
In New York State (NYS), Black women are more than three times as likely to die from pregnancy or giving birth as white women. This disparity has persisted alongside the U.S.’s rising maternal mortality rate, which has doubled in the past 15 years. Recognizing the urgent need for change both within their state and across the nation, NYS launched an initiative to engage women of color in identifying sustainable solutions for improvement.
Using an Equity Lens to Reduce Maternal Mortality in Louisiana
Louisiana has one of the highest maternal mortality rates in the country. And troublingly, Black women are dying from pregnancy-related deaths at over four times the rate of white women. According to a recent report, more than half of these deaths could have been prevented by making a system change, either at the patient, community, or hospital level. These findings illustrate the enormous potential that quality improvement initiatives have for reducing maternal mortality in Louisiana and eliminating the Black-white disparity in maternal deaths.. Here, the Louisiana Perinatal Quality Collaborative shares seven opportunities for improvement.
Five Strategies for Building Diversity in a Patient Family Advisory Council
Improving health care systems to address persistent health disparities requires partnering with the people those disparities most affect. Only they can accurately describe their experiences and share what barriers they’ve encountered. This is why it's vital to build diversity into patient family advisory councils.
Ohio’s Multi-Pronged Approach to Addressing the Opioid Crisis
The Ohio Perinatal Quality Collaborative is testing innovative strategies for improving outcomes for the thousands of families affected by the opioid crisis. Here, they share their approach, including standardizing identification and treatment for opioid exposed infants in NICUs, encouraging compassionate responses from providers, and ensuring comprehensive, coordinated maternity care.
Breastfeeding Priorities: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave
In honor of National Breastfeeding Month, we’ve taken time with NICHQ Faculty Expert, Lori Feldman-Winter, MD, MPH, an internationally and nationally recognized expert on breastfeeding nutrition, education and policy, to recognize successes and learn about opportunities for improvement. Her frank description of bias and her passion for promoting gender-equitable social norms have inspired us to continue pursuing sustainable improvements.
It Takes a Community to Save Babies
By partnering with community programs and organizations, public health initiatives can give families opportunities to learn about safe sleep from trusted members of their community who share their lived experience. Here, find six strategies for engaging community partners, maintaining that partnership, and collaborating to raise awareness.