Using the Perinatal Periods of Risk PPOR Approach to Implement Preconception Health Policies and Pro

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Using the Perinatal Periods of Risk (PPOR)
Approach to Implement Preconception Health
Policies and Programs

• Amy L. Johnson, BS, MPH Candidate

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CityMatCH Mission
Improving the health and well-being of urban
women, children and families by strengthening
public health organizations and leaders in their
communities.
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PPOR Practice CollaborativeParticipating Cities
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PPOR is

• Adding new tools to help solve some very old
  problems
• Translating data into action
• Changing the way we do business

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PPOR 6 Step Approach

• PPOR is a Six Step (Comprehensive) Approach to
  Address Fetal-Infant Mortality
• Step 1 Assure Analytic and Community Readiness 
• Step 2 Conduct Analytic Phases of PPOR
• Step 3 Develop Strategic Actions for Targeted
  Prevention
• Step 4 Strengthen Existing and/or Launch New
  Prevention Initiatives
• Step 5 Monitor and Evaluate Approach
• Step 6 Sustain Stakeholder Investment and
  Political Will

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Building the PPOR Map

• Use linked infant birth death file

• Include fetal deaths

Do NOT include
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PPOR MAP
The cells in the PPOR MAP HELP INDICATE THE
ACTIONS NEEDED
Age at Death
Birthweight
These four groups are given labels that suggest
the primary preventive direction for the deaths
in that group.
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PPOR Analytic Phases

• Phase 1 Identifies the populations with overly
  high rates of mortality and estimates excess
  deaths.

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Perinatal Periods of RiskWhat is the Gap?

• ASK Which women/infants have the "best"
  outcomes?
• ASSUME all infants can have similar best
  outcomes
• CHOOSE a comparison group(s) (reference group)
  who already has achieved best outcomes
• COMPARE fetal-infant mortality rates in your
  target group with those of the comparison
  group(s)
• CALCULATE excess deaths ( target comparison
  groups). This is your communitys Opportunity
  Gap.

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CALCULATING THE GAP Using External Comparison
Group Urban County, 2000-2002
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PPOR Analytic Phases

• Phase 2 Explains the excess deaths. Communities
  examine reasons for excess deaths through further
  epidemiologic studies, death reviews, program and
  policy reviews and other assessments.

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All PC cities discovered that they need to
target the Maternal Health / Prematurity Period
of Risk

• Preconception Health
• Health Behaviors
• Perinatal Care

500-1499 g (VLBW)

1500 g
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Orlando, Florida1998-2001PPOR Results All Races
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Orlando, Florida1998-2001PPOR Results Black
White Races
Fetal Death
Post- neonatal
Neonatal
Maternal Health/ Prematurity Black N84, Rate
5.96 White N104, Rate 3.71
500-1499 g
Maternal Care Black N52 Rate3.69 White
N88 Rate2.30
Newborn Care Black N34 Rate2.41 White N45
Rate1.17
Infant Health Black N47 Rate3.34 White
N64 Rate1.67
1500 g
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SAVE OUR BABIES CAMPAIGN
Initiating community partnerships with local
minority businesses
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Jacksonville, Florida1997-1999PPOR Results All
Races
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Jacksonville, Florida1997-1999PPOR Results
Black White Races
Fetal Death
Post- neonatal
Neonatal
Maternal Health/ Prematurity Black N105, Rate
8.61 White N68, Rate 3.0
500-1499 g
Maternal Care Black N32 Rate2.62 White
N47 Rate2.08
Newborn Care Black N21 Rate1.72 White N36
Rate1.59
Infant Health Black N32 Rate2.62 White N31
Rate1.37
1500 g
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FIMR RESULTS(Duval County Florida 1995-2002)

• Maternal Health and Prematurity Period of Risk
  (N45)
• 44 Preterm labor
• 38 PROM
• 31 Maternal infections other than STDs
• 31 PPROM
• 27 Infections (baby)
• 27 History of fetal/infant loss
• 22 Pre-existing medical condition (baby)
• 22 Substance abuse

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The Magnolia Project
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PPOR is about results

• Developed consensus within Floridas Department
  of Health and the Florida Association of Healthy
  Start Coalitions to expand Healthy Starts focus
  to one of pre/interconception care
• Formalized protocol and interventions for
  pre/interconception care model within Healthy
  Start
• Educating MCH partners around the state on
  disparities in area of maternal/preconception
  health
• A new approach, to think beyond just prenatal
  care access and quality
• March of Dimes MCH Prematurity Leadership Summit
  findings need stronger focus on
  pre/interconception health

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PPOR is about impact

• Builds data and epi capacity
• Promotes effective data use
• Strengthens essential partnerships
• Fosters integration with other key efforts
• Encourages evidence-based interventions
• Helps leverage resources
• Enables systems change for perinatal health

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Cities who have used PPOR have concluded that . .
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• PPOR links analysis to action for preconception
  care
• PPOR can complement enhance existing efforts
  focused on preconception care