Judul : Northwestern Institute Of Health And Technology
link : Northwestern Institute Of Health And Technology
Northwestern Institute Of Health And Technology
>>> good morning. good afternoon. good evening. depending on from when and whereyou are joining us. it's my pleasure to welcome youto cdc public health's grand
Northwestern Institute Of Health And Technology, rounds for november 2015. public health strategies topreventing pre-term birth. let's get started. first, a few house keepingslides.
public health grand rounds hascontinuing education credits available. see our website for additionaldetails. we also are available on all ofyour favorite social media sites and we are live tweeting today. we are taking questions, you cane-mail them to grand rounds@cdc.gov, thank you. we have a featured video segmentcalled beyond the data, which is posted shortly the session.
this month's video features dr. david lakey. we have partnered with the cdcpublic health library to feature articles related to pretermbirth. the listing is available atcdc.gov/library/slide clips. here is a preview of up comingevents, join us live or at your convenience. and in addition to ouroutstanding speakers, i would like to acknowledge theimportant contributions of
individuals listed here withoutthem, this wouldn't be possible. so thank you. and if they were here, i wasgoing to welcome the march of dimes people. and the jack and jillincorporated visitors. and now had, for a few wordsfrom cdc's deputy director. >>> well, thank you so much, andgood morning everybody and welcome to our special visitorsand presenters.
the public health grand groundsis timed to the second, so we did not factor in securitytoday, and i'm sorry that our march of dimes colleagueswill miss the beginning. pre-mature delivery is a bigprogress. i had a personal interest inthis since medical school, when i saw what the devastatingaffects that very preterm delivers could have. my interest in this increased inmy early work at cdc, when we saw that double whammy ofinfection in newborns and severe
prematurity. i was skeptical of this topic. it seemed to me, a big problem,but something that i thought there was little we could dobit. what i-- we could do about it. what had i learned is there atremendous set of progress since i lost worried about thiscondition. like many of our issues, it'scritical that we break it down and take a methodical approach.
and today's session will do thatand also, highlight the promising avenues that areavailable. how we measure and compare isimportant and necessary to monitor how we are doing and youwill see how it's been an important factor. the health care system, that isso important in our work, trying to strengthen that link betweenpublic health and health care. turns out to be both a problemand a prospect for the condition.
in some cases we are doing toomuch in the health care system. in terms of induced deliveries. and in other cases we are doingtoo little. some of the drivers weredifficult to tackle. the social determinance ofheal rears their ugly head and how we address it is important. but there's key strategies thatinvolve focus, target setting, working together acrossorganizations and institutions and fostering engagement.
and some of the peekers will hadspotlight exciting best practices and partnerships thatthat are really making a difference right now. >>> as you know, prematurityaffects the mother and the baby a, you can have life long consequences for families andschools and for the nation's future. discussion of preterm birthprevention requires taking a look, beginning, i think withhealthy skepticism and leading
to optimism, that through focusand partnerships we can make a big difference. let's get on with it. i look forward to today'sspeakers. [ cheers and applause ]>>> thank you, doctor and for our first speaker. >> good morning. today, i will be speaking aboutpre-term birth in the united states.
but before i continue, i want totell you a story of two births. in 1963 a woman delivered a babyboy by emergency c-section, just over 34 weeks gestation, hisname was patrick. the second son of president johnf. kennedy and his wife jacqueline. though normally formed, patrickhad great difficulty breathing from the start. as a result of a prematurityrelated lung disease, sadly he died two days later.
now, let's fast forward to 2001. a woman is transported to ageorgia hospital in preterm labor and delivered a baby boyat 34 weeks gestation, before this baby's early arrival, sheis given a shot to help her baby's lungs to develop morerapidly and they slow down the labor. he was dig charged to his homefive days -- discharged to his home five days later. and the next baby is my sonhe is here with us today and
living a happy and healthy lifemodern medical technology and effective public healthstrategies have drastically reduced pre-term birth andinfant mortality, yet, too many babies are born too early in theunited states. most pregnancies last 40 weeks. an early pre-term birth is atleast six weeks before. a late preterm birth is betweenfour and six weeks before. and now, let's look at importantstatistics. the societal costs of thepreterm births are staggering,
as the infants are at increasedrusk of death and survivors are at risk for respiratory, centralnervous system, hearing and vision problems. as well as longer termdevelopmental problems. can according to a 2005estimate, the societal burden related to the preterm birth andits consequences is $26.2 billion. in addition, this affects racialand ethnic groups. further increasing, health andsocio-economic disparities.
the prevention must srtearlier than during pregnancy and prenatal care. because our infant mortalityrate is two to three times higher than that of otherdevelop countries. in fact, we are at the rankingbottom. even when we adjust for infantsborn before 24 weeks gestation, we rank poorly at 4.2 deaths. our high rate of preterm birthis the primary factor driving the high infant mortality ratein the united states.
let me explain why. after the fda approval ofpulmonary surfactant, the infant mortality rate declined. better neo-natal care andprenatal care drived down infant mortality rates as well. but around the turn of themillennium, the rate of decline slowed dramatically. what happened? the returns from medicaladvances such as ventilators and
anti-natal steroids diminished. there's a massive spike inmortality at the earliest pre-term babies. babies that are less than 32weeks gestation or earlier, our tiniest babies bear the biggestburden. 9.6% of all live births arepreterm, yet 67% of infant deaths of babies in the u.s. areto preterm babies. nearly 350,000 american babies are born too soon. the overall preterm birth rate,based on last normal mensies
is -- and rates for americanindian, agriculture alaska natives is 13.4%. though the rate declinedrecently, too many babies are being born too soon. and the gap is wide. when if infant mortality ratesof the pre-term babies are looked at by race and ethnicity,the disparity is more shocking. pre-term related causes drive alarge proportion of nonhispanic black infant deaths in the us.
preterm relateddeaths cause for nonhispanic blacks are more than three timeshigher than that of nonhispanic whites. finally of course although notshown here, other disparities are seen for native american,and other sub groups of hispanics when paired tononhispanic whites. so, let's quickly recap. when you have two many pretermbabies, with low know which as of survival, you will have ahigh infant mortality rate.
in the u.s., the high rate ofpreterm birth among black mores is a primary driver for infantmortality. to lower overall rates we mustaddress the racial and ethnic disparities in preterm birth. but doing so is easier said thandone. why is it so difficult toprevent preterm birth. it's a complex disorder, theresult of social, behavioral, d biologic risk factors. for example, stress itself caninflame many tissues and make
pre-term birth more likely whileamplifying the risks of other risk factors here. this extensive list of riskfactors mirrors that of other chronic diseases. black race, and a history ofprior preterm birth are the strongest predictors. how do we solve the complexproblem in we must focus on four areas. >>> first, we must improve datafor surveillance of pre-term
birth. without better data, we cannotfully understand what drives pre-term birth. nor can we better target theintervention. and second, we must continue toresearch pre-term birth. particularly early pre-termbirth and employ best practices to prevent it. third, we must improve thequality of care, especially for disparitily affectedpopulations.
and finally we must continue tostrengthen community partnership. for pre-term birth. it is critical to move findingsfrom research in to practice. our relationship with partners,and our leadership our ability to convene collaborators to comeup with strategies for prevention is important. surveillance is a fundamentalfunction of cdc and an essential component of surveillance is theaccurate case definition.
birth certificates provide theonly information with which to conduct surveillance. we have transitioned from usingthe date of lmp, this will allow us to better target high burdengroups. we must utilize and link data toprovide much needed information on women, and infants in theircommunities, for example, data from cdc a's pregnancy riskassessment monitoring system provides such information. we can also measure and targetthe social determinations of
health that drives racialdisparities. this includes the use ofgeographic data and data linked over time, in the end, thehealth of the infant reflects the health of the community. we need more research in to theetiology of preterm birth. but, we can act to prevent therisk factors we already know about. babies need to be delivered atfull term. stopping this process earlywithout a medical indication can
result in adverse outcomes forthe infant. public campaigns, communicatingthat a baby grows to full term can be successful. next, we can reduce teenage andunintended pregnancy rates. teenagers are at risk forpreterm delivery and are more likely to have a second babywithin two years after the first a trend that makes pretermdelivery more likely for the second births well. the teen birth rate has droppedsubstantially.
we need to improve the health ofwomen prior to pregnancy to reduce maternal risk factors,such as tobacco use, obesity and diabetes. it has been estimated that 5.3to 7.7% of preterm deliveries and between 5 and 7% of pretermrelated deaths were attributable to prenatal smoking. >>> lastly, the risk of pretermbirth is higher among multiple gestations. these births are attributed toassisted reproductive
technologies and more to the useof non -- not fertility. to improve the quality of care,and to both mothers and babies, we must improve preconceptionhealth. primary care providers must askwomen if they intend to conceive and if they do not wish to,providers must provide appropriate contraceptives, wecan provide access to appropriate post-partumcontraception, since short pregnancy intervals can resultin preterm births. improved access to the mosteffective prematurity prevention
treatment is critical. finally, cd has worked withorganizations like the national institute of child health anddevelopment, and march of dimes to demonstrate the risksassociated with pre-term birth. this collaboration has providedevidence for professional organizations such as theamerican academy of pediatrics and the association ofobstetrician. is to change practice in thecare of nonpreterm infants. the collaboration on innovationand improvement, will help
improve clinical and publichealth practice, across the united states. in order to strengthen communitypartnerships, we need to continue to build capacity incommunities. cdc is working with the bureauof child health to do this. it has been successful inproviding technical assistance with states with mch capacityreported as one of two areas with increased capacity by thecouncil of state and territorial epidemiologists, we need to makean investment in governmental
and public private partnershipsto strengthen the visibility of the problem of pro-term birth. supporting legislation such asthe preemie act, and not elective deliveries. and secondly, we can help tosupport communities by translating scienceappropriately in to relevant clinical and public healthpractice. i want to go back to the storyof to births that i told you about from the beginning of mypresentation.
i'm confident that in thefuture, we can tell a story about two births that resultedin two full and happy lives. instead of only one. but with, to do this. we must focus our efforts on thedisparities driving pre-term to do this, we must act withcourage and employ best practices and innovate with newand existing data and more importantly collaborate witheach other. and now, i will introduce dr.
art jane. [ cheers and applause ]>> good morning. since 1980, the nation's overallinfant mortality rate has declined -- infant per 1,000live births. however, the national decline ininfant mortality has not been equal for everyone. so let's look at a little bitmore data. what we have seen is encouragingdeclined in infant mortality in the united states for blackinfants the mortality rate is
twice the rate of white infants. and despite drops in rates norboth races, this critical gap has not narrowed. in 2013, black infants died at2.2 times the rate of white infants. and higher infant mortalityrates are associated with many risk factors, including beinguninsured or on medicaid, smoking. having a high school educationor less, or being over weight or
obese throughout thispresentation, we will discuss some of the social determinatesof health that drives the risk factors on how african-americansare affected. regarding the achievement ofhealthy people's goals, for white infants we met the overallinfant mortality rate goal in 1986. but for black infants thehealthy people 1990 goal rate of 12 shown with the blue dashedline, was not achieved until 2010.
even though the healthy people1990 black infant mortality rate goal was higher than the overallgel, there was a 24 year gap between achieving the goal forwhites than for blacks. for healthy people 2000. we away achieved the goal forwhites and again, well in advance of the goal date. for healthy people 2000 infantmortality rate goal for blacks was 11 and in 2013, we arealmost there with an infant mortality rate of 11.2.
but there's a 21 year gapbetween achieving the goals for whites and for blacks. healthy people 2020, infantmortality rate goal for all races is a rate of six is. we achieved that rate for whitein 1996, a full 23 years in advance of the target date. if we don't dramatically improvethe pace of improving the black infant mortality rate the shiedshows us that we will not accomplish that goal for blacksby 2020.
this is also astounding to knowthat our historical best rate for black infants was achievedin 2013. yet it's higher than we haveseen for white infants in the last 33 years. >>> if this pace of improvingthis disparity does not improve black babies will have to weightin the 2046 to have the same opportunity of surviving thefirst year of life as white babies in the united states didin 2013. as was mentioned, preterm birthis the most frequent cause of
preterm deaths. >>> african-americansexperienced the most disproportionate rate of pretermbirth. to turn the tide in infantmortality, we have to tackle preterm birth, that meansgetting to the root of high preterm birth rates inamericans. race and ethnicity alone cannotcontact for this. genetics is alone, as related torace has not been shown to account for differencesprematurity.
while a woman cannot change herrace or genetics in general, the public health officials andcommunity leaders can focus attention -- sorry. can focus attention oninequities in public health and health care to eliminate thedisparities. by highlighting the racial andethnic disparities and inequalities, we are showinghealth officials and community leaders where they should focustheir attention and resources. this can help to developculturally appropriate programs.
the march of dimes stork's twas of designed. and other prenatal programs havebeen shown to reduce young pre-term birth rates, and versushealthy start programs, face to face community based managementprograms. it has 25 years of improvinginfant mortality in some of the most under resourced locations. highlights the racial gaps mayhelp attract the interest offers and grants to support findingthe underlying causes of the gaps.
just 1/3, or 31% of declines inu.s. infant mortality rates were due to declines in pre-termbirths. this figure isdisproportionately low for the white counterparts. given that the driver of infantmortality in the united states is preterm birth amongafrican-americans and only 44% of the reduction in infantmortality among african-americans in recentyears is due to efforts to reduce preterm birth rates, ourefforts are not effectively
targeting african-americans orthe medical interventions have reached their limit. as mentioned earlier, pretermbirth is complex. it reflects a combination ofsocial behavioral, clinical and biological risk factors andcauses. speaking to preterm birthbroadly, bowing black is one of the strongest predictors ofpreterm birth. listed above are some of the keycontributors to pre-term birth among african-americans.
infection and stress playimportant roles since they elicit an inflammatory response. is there one common pathway thatpossibly incorporates all of the above factors? what if we consider thehistorical legacy of race and the influence of racism as apossible contributor to this disparity. recall the differential exposersto risk factors represented here by downward arrows over the lifecourse affect the development
trajectories and contribute todisparities in birth outcomes. help understand the complexfactors that influence health outcomes among african-americanswe have to take a brief look at history. in reality, only 13% in theafter condition american experience is taken place sincethe civil rights movement. a full 87% of this experiencewas spent in slavery, or under jim crow laws. youthe systems built over the first 350 years of theafrican-american experience are
still influencing healthoutcomes today. place is a contributor. historical concepts like redlining, this that a is legally limiting where black peoplecould live continues to play an important role in healthoutcomes for african-americans the today. in this red line areas inchicago, the red areas are low income, largely minorityneighborhood that were marked by the homeowner's loancorporation as hazardous real
estate markets. the red lining and welldocumented history of what transpired in red linecommunities. higher rent, unfair mortgages,poor schools, concentrated poverty and increased crime. less green space and investmentsby banks, poor public transportation. threats and fear from the kkkand linchinges, inability to access good schools.
that means thatafrican-americans were exposed to the stress of poverty,racism, no insurance, limited a access to care, whichfacilitated less late initiation of care. etcetera. according to the kirwaninstitute, and the influence of red lining, disturbing is therelationship between red lined areas, shown here in the upperleft hand corner of the slide, and having infant healthoutcomes shown in the lower
right hand corner of this slide. areas that were deny equal access to areas ofmortgage rates, higher foreclosure rates and the higher -- infant mortality rates. so, let's go back to our list offactors for a minute. i would point to two really keyfactors, stress, and genetics, that we will define as theprocess by which environmental events determs how genes work.
if the influence on our bodiescan be passed on, then what if 350 years of sustained extremestress over many generations, what kind of influence has thislevel of stress had and how does it influence pregnancy outcomes. today, we know the playing fieldis not level when it comes to health care and outcomes in thecountry. with we know that systemicfactors like education, labor a and housing markets, and healthcare systems can all influence individual health okayhealth outcomes.
individuals cannot control thefactors on their own, they can only be changed through socialpolicies, and political processes. moving forward, will require afew key shifts to the way we think of health of individuals. first, we need to adopt a lifecourse perspective. that means assessing the role ofearly life, life long and perhaps generation alex posers,whether they are biological or socio-economic.
and see how they accumulate andmanifest as disease. additionally, we have to addressstructural factors at their root. because the same factors thatinfluence infant mortality also influence other healthconditions, by broadly addressing the structuralinfluences for mortality in african-americansacross the board. to do the things i mentioned inthe previous slide, we have to aim for equity.
not equality. that concept means the inputs weneed to -- will need to be different to achieve equaloutcomes. in the picture to the right, yousee equality. each child receives the samesize box to stand on, regardless of height. you see equity, a childreceiving the box tailored to their height so they can see thebaseball game. that's what we need to aim for.
>> most work in the spacesuggests that interventions need to move upstream, they needto -- housing and transportation, etcetera. we know that these things make adifference, but we do not seem to be solving the problems orimplementing the stream improvements. if we know that scarcity insocial disparities makes the outcomes that we are tryingimprove it worse, this is our challenge moving forward.
incorporate social determinatesand clinical interventions, and make sure they reach who needsit the most. and we have to do it all withoutcompromising the progress we are making amongst white infants. clearly more research isnecessary to validate stress. and the mechanism that it ispassed on to subsequent generations. the goals are for us to focus toeliminate preventable disease, disability, injury, andpre-mature death.
and to achieve health equity,eliminate disparities and improve the health of allgroups. create social and physicalenvironments that promote good health for all and promotehealthy development and healthy behaviors across every lifestage. and now, i would like tointroduce dr. henderson. [ applause ]>>> good morning. during this presentation, i willdiscuss cdc support of state-based peri-natal effortsto improve neo natal outcomes.
state peri-natal collaborativesor pqcs are networks of providers in public healthprompts working to improve pregnancy outcomes by advancingevidence based clinical practices through continuousquality improvement. pqc members identify careprocesses that need to be improved and use the bestavailable methods to make changes and improve outcomes asquickly as possible. state pqcs, include key leadersin public, private and academic health care settings inexpertise with quality
improvement. the methodology used by pqcs isbased on quality improvement principals developed and used inother disciplines and specialties and depending onbaseline and ongoing collection of data, and rapid return ofdata. >>> and rapid return of data tomeet objectives and improve care. although individual institutionsand organizations have been able to achieve some improvements inperi-natal care, regional pqcs
serve a unique role, they takeon the responsibilitity of improving outcomes for theentire population of the region, they understand the regionalnetwork of peri natal care, and they collaborate among teens inhospital and community settings and have the ability to comparethe performance of hospitals that are operating within asimilar context. members of a regional peri-natealabama quality initiative, represent a community of change,and this model has been shown to be successful for rapiddissemination of protocols and
kr cdc is supporting pqcs tohelp expand current efforts and to use the experiences andknowledge gained to help other including developing a resourceguide to provide assistance to states that may wish to formpqcs and are facing challenges with pqc developments and theformation of a national network pqcs across the country. and state pqcs currentlysupported by cdc include california, new york, ohio,illinois, massachusetts and north carolina.
let's look at the ways they havesuccessfully reduced preterm births and improved neo-nataloutcomes. choosing to deliver before 39completed weeks, or full term, without a medical reason to doso, can pose serious risks to the mother and the baby. many states have rallied behindreducing the number of scheduled deliveries without a medicalindication that are less than 39 weeks gestation, also known asearly, elect i have deliveries. there's different approaches toreach the common goal, however,
all efforts have included someor all of the following approaches. including having championleaders to get buy-in and participation providing heeducational resources to reinforce objectives to improveoutcomes and improving documentation, and indicationsof delivery. and review of site specific anddata to review goals and effectiveness intervention, andtrouble shooting of systematic local issues, including there-access of interventions
that have been implemented. >> across the country. the rate of early electivedeliveries continues to fall. this rate has decreased and forthe second year the national average hit the target rate ofless than 5%. here is an example of successachieved by reducing early elect i have deliveries in new yorkstate. this effort began in september2010, among new york state region aregional peri-natal centers.
the pqc partnered with the newyork state partnership for parents in march 2012, andexpanded in june 2012 to include affiliate hospitals with 96hospitals in total. they were abe to achievesignificant declines in deliveries without a medicalindication at all of their participating sites. including the regionalperi-natal centers affiliate hospitals. the success in reducing theearly deliveries have met and
exceeded the target rate of 5%. i will discuss another strategyused by pqcs to reduce preterm births. and preterm birth is the numberone cause of newborn death in ohio. progesterone is a therapy shownto reduce preterm birth by 30%. the ohio peri-natal qualitycollaborative or opqc is currently estimatetesting strategies. successful strategies will beimplemented in other practices.
the aim of the project is toreduce the rate of preterm births in ohio, by increasingthe screening, identification and treatment of pregnant womenat risk for preterm birth who will benefit from progesteronetherapy, in 2012, two sets of guidelines were publishedregarding the use of progesterone for the preventionof preterm birth. one by the society of medicine. the smfm algorithm starts withall single ten pregnancy. the a-cog algorithm starts withpregnant women that have been
identified with a short cervix. the ohio pqc uses a mergedprotocol that starts with all patients at the first prenatalvisit. it includes universal screeningor screening for short cervix and bases it on a history. they do not recommend oneprotocol over others but promote the importance of prenatal careproviders choosing one of the approved protocols to screen allwomen. a key part of their efforts wasa development of various
informational brochures. let's look at the preliminaryresults from this project. these are run charts, depictingthe percentage of pre-term births in ohio, using birthregistry data, for each month, starting january, 2012 throughaugust 2015 in women with a history of spontaneous priorpre-term birth. the progesterone project beganin 2013. the run lines on top for thesites participating in the project, and if ones on thebottom are for all hospitals.
less than 32 weeks are on theright. the solid red line in each graphis the median rate. about nine months afterbeginning the project, there was a small decrease in the rate ofpreterm births before 37 weeks and before 32 weeks gestation,indicated by the red arrow. the decrease was noted at opqcparticipated sites where 50% of ohio births occurred and atall ohio maternity hospitals. women with a history of priorpreterm birth make up more than 80% of the women identified forprogester on one therapy.
in addition to work to reducepreterm births, pqcs have worked to improve outcomes for infantsborn preterm as well. and anti--natal steroids havebeen known to reduce the death of pre-term infants. rates should be optimized toreach more than 90% of pregnant women to improve the outcome forbabies born too soon. opqc has worked to improve thepercent of pregnant women between 24 and 34 weeks who wereat risk of pre-term birth and receive ancs prior to delivery.
and including efforts to improveaccurate documentation of steroid therapy. >>> since opqc began theirproject to improve the documentation and reliability ofa these medication, they are closeto reaching the administration rate goal of 90%. recent efforts have focused ondissemination on the ancs project of all ohio maternityhospitals. many that deliver early arefirst seen in smaller hospitals
and are then transferred fordelivery to larger hospitals. opqc discovered that the first dose was given in a smallerhospital in 40% of women treated. they worked to develop a toolkit that was disseminated to hospital teams as well as sharedvia webinar to a how them to reach sites that were notinvolved in the original ancs project. this tool kit, includesstrategies to facilitate before
transfer, as an important stepfor regionalized care in preterm >>> here, we are continuing towork to support pqcs and share best practices with other statesthat are trying to achieve the same results. here's a screen shot of our webwith -- our web page. we are hoping that it will be aresource to help other states. in addition to contactinformation for pqcs across the country, this website containswebinars on topics relevant to building and sustaining a pqc,we are also developing a
comprehensive resource guide forpqcs that will be made available by the summer of 2016. cdc is also supporting thedevelopment of a national network of state peri-natalquality collaboratives. the network will be a mentoringresource to increase compacity states to improve maternal andinfant health, with the goals to strengthen existing leadershipsand identify and sustain and establish pqcs and to identifyand develop tools, training and resources.
the march of dimes is alsoleading the development of this national network with cdc. to support and encourage datadriven, quality improvement processes, to improve maternaland infant health across the country. i would now like to turn thepresentation over to -- [ cheers and applause ]>> good morning everyone. i want to greet my march of -- dimes and jack and jill
colleagues that braved securityand finally made it to the presentation. welcome, welcome. [ cheers and applause ]>>> i have the honor and the privilege of joining you thismorning to celebrate progress and prevent premature births inon our great country and also to invite us all to roll up sleevesand proceed with the next phase of work that needs to beaccomplished. so, in 2003, the march of dimeslaunched a national pre-
maturity prevention campaign. i must say there was a anatmosphere of skepticism at the time, but that was soon overcome. the goal -- the two goals of thecampaign were first to raise public awareness, about theproblem of premature birth and to demonstrate this problem wascommon, costly, and very serious in terms of health consequences. and secondly to seek and findand bundle interventions that could reduce the rate of pretermbirth in our country to 9.6% by
2020, that was the goal that wasset in 2003. now, the essential first stepwas to identify public/private partners to get the job done. we have always appreciated thecollaboration with our federal partners, of cdc and hrsa, andnichd in the early stage of the campaign, we alsorecruited partners, who have remained with us for theduration of the campaign. maternal and child health, stateprofessionals, pediatrician, the state health officers andterritorial officers, the
association of women's obstetrichealth and neonatal nurses and the association of city andcounty health officials. in addition, we recruited andsupport 42 alliance members. now, to fast forward from 2003,to the present time we have reached our 2020 goal of 9.6%,two reasons. first of all, there areabsolutely fewer pre-term babies being born today since the peakyear of 2000 and sick. 231,000 fewer preterm births inthe u.s. secondly, we got a bump, a boost in the definitionof preterm births by the cdc's
center for national healthstatistics but the drop in premature births is roughly madeup of half, 50/50 of each of the factors. now, progress is not victory. celebrate, but it's not victory. because despite ourimprovements, the rates preterm birth in the unitedstates, as you saw earlier slides we rank, very, verypoorly among the developed countries of the world.
when it became apparent due tothe absolute reduction to the technical change, to our marchof on dimes to our partners, to our board. we over the summer reset thegoals, the 2020 goals, we set a goal of 8% for 2020, with all ofthis, with a full support of the national board of trustees andset a goal of 5.5% or better by 2030 to be in sync with theunited nations new sustainable development goals. we reset the 2015 annual reportcard, to this 8.1% goal.
and very, very importantly, weestablished a new focus on high volume, high burden areas andpopulations in the report card and in the road map that we haveprepared to achieve goals. and i'll come back to the focuson high volume, high burden areas, it's really been the sumand substance of all of the presentations that you are haveheard so far it about how do we achieve equity. how do we reach the goals, weneed to continue existing interventions r we haveactivities in all states in the
district. and it's very important now, asyou heard from previous presentations that we acceleratechange in 16 high burden areas. and particularly that we targetgeographies and racial and ethnic groups with high rates ofpreterm birth and high birth volume. so what the -- what is the roadmap? it divides in to two phases andphase one, are the states and territories with the highestpreterm birth rates.
so there's five states and oneterritory. alabama, louisiana, mississippi,an puerto rico, that had the highest rates in the country. and florida and texas, which arethe most populous high rate so we are going to be invitinghealth leadership, and local health leadership in theseareas, over t next year and a half to really step forward andget involved in supporting progress for the road map. phase two, are the additionalstates with large burden of
these are states with over100,000 births a year. california, georgia, illinois,ohio, pennsylvania and virginia. the road map consists of thedevelopment of tools, and bundling around eight evidencebased interventions that have deny demonstrated to lower riskand lower rates of premature they are familiar to each andevery one of you in the room. and across the country. group care, reducing multiplebirths, conceived through art and low-dose aspirin to reducepreeclampsia, we are almost
there america, let us a stay on the track with this. access to progesterone shotseach of the interventions have a a lot of unrealized potential. they are more applicable in someareas than others. so we have to match up the rightbundles in the right intensities in the high burden areas. we need to continue to engageour current and new stakeholders to increase the awareness ofdisparities and the evidence based practices.
so that we can link the two. this is the 2015 premature birthreport card that was issued. so we issued it with ourpartners the first week of november. and if you are a blue or purplestate, keep up the good work. if you are a yellow or orange orred we need to work together even harder to bring our nationforward. we need to continue to engagestakeholders and quality improvement, evidence andpractice.
you heard a wonderfulpresentation from dr. henderson about the pqcs and theirpotential has still much to be analized, this really is in theright direction. many of us in the room will betraveling to washington today to participate in the thirdnational march of dimes prevention conference. he will had use the keynote to formally introduce the road map and an 8.1% goal 2020for the u.s. and we are grateful to funding for the from thegrant for the division of
reproductive health at cdc solet let's continue doing what we aredoing. we will focus on the highvolume, high burden areas. one more thing that we need todo. we need to bring science forwardfaster. to build a biologic model thatexplains the initiation. so the march of dimes has invested in five research centers. as we gather together, there's300 scientists that are focusing
on this question. why do women go in to labor tooearly. what are the bases of the modelthat can explain human labor. those five centers are stanford,a collaborative in ohio. a slab active in chicago withnorthwestern and duke. a center at with a universityin st. louis. and a center in the universityof pennsylvania, in addition, we have nine collaborativeuniversities and institutions. and they are very focused onbuilding a model and translating
findings in to new upstream riskdiagnostics and interventions. summing up. partnership works andprematurity can be prevented and preterm birth has decreased overthe following seven years, 231,000 fewer absolute prematurebirths. the road map activities willhave a pro found, positive impact and they are producing ahealthier birth in our country. 210 fewer -- 10,000 fewer babieswill be preterm when our 1.8% goal is met in 2020 and1.2% fewer babies born preterm
when we meet the goal in 2030and cumulative from today, 1.3 million fewer babies bornpreterm. next steps, activating the roadmap in the 16 high burden, high volume states and continuing towork together to focus on the prematurity prevention. for those of you who love chartsand graphs, here is our study as a nation. from 2006 to 2013 we had a drop.the goal of 8.1% will allow a 15% drop when we are successful.
with your help, we can achievethe goals. everyone has a role to play andtogether we will be successful thankyou very much. [ applause ] >> i think we are out of time, iwould like to thank the speakers and the march of dimes visitorswho i'm sorry you missed the first part of the presentation,it is post online shortly. i'm sorry we did not have enoughtime for the questions with. send the questions to the grandrounds mailbox and all of your
questions will be answered. thank you for joining us, [ cheers and applause ]
Demikianlah Artikel Northwestern Institute Of Health And Technology
Anda sekarang membaca artikel Northwestern Institute Of Health And Technology dengan alamat link https://yanderatjen.blogspot.com/2017/06/northwestern-institute-of-health-and.html
0 Response to "Northwestern Institute Of Health And Technology"
Posting Komentar