Sub-Goal: Reduce disparities in quality of care across populations and communities 12.1. Reduce the infant mortality rate (IMR) among Healthy Start program clients. 12.2. Reduce the neonatal mortality rate among Healthy Start program clients. Results of this measure will be reported in October 2015.
12.3. Reduce the post-neonatal mortality rate among Healthy Start program clients. Results of this measure will be reported in October 2015.
Goal: Improve Health Equity
Sub-Goal: Monitor, identify and advance evidence-based and promising practices to achieve health equity
12.III.A.1. Increase annually the percentage of women participating in Healthy Start who have a prenatal care visit in the first trimester.
Healthy Start focuses intensive outreach efforts on enrolling hard-to-reach, high-risk women in prenatal care. The percentage of women participating in Healthy Start who had a prenatal visit in the first trimester fell from 70% in FY 2004 to 68% in FY 2006 and rose slightly in FY 2008 to 68.5%, which was below the target. Healthy Start was not successful in meeting its target of 75% entry into prenatal care due to a resurgence of barriers to access to care, such as state budget crises, changes in financing of prenatal care at the State level, a shortage of obstetric providers due to professional liability litigation and malpractice coverage factors, and a growing trend among obstetric providers to delay the first prenatal health care visit until early in the second
86
trimester. Along with the resurgence of these factors, many projects adjusted their project areas to include new neighborhoods where there was a significant need for the program (e.g., high rates of infant mortality and other adverse perinatal health outcomes).
Healthy Start is continuing to work with individual projects on identifying the challenges in their local communities as well as sharing among projects successful strategies to improve access. A learning collaborative model program has been established to further assist projects in strengthening their project’s capacity to offer primary and support healthcare services to participants. The program has also identified and synthesized evidence-based practices that contribute to improved perinatal outcomes and disseminated this information to the HS communities.
Future targets for this measure are set at 75%.
12.III.A.2. Decrease annually the percentage of low birthweight infants born to Healthy Start program participants.
Healthy Start is designed to reduce adverse perinatal outcomes, such as low birthweight (LBW) and infant mortality, by helping communities identify, plan and implement a diverse range of interventions to support and improve perinatal delivery systems in project communities. Because Healthy Start participants are among those at highest risk for poor perinatal outcomes and the hardest to engage in ongoing preventive healthcare, improved health outcomes are harder to achieve than in the general population.
Low birthweight is associated with an increased risk of infant death; an infant’s size at birth is also a key predictor of short and long-term health status. The percentage of low birthweight babies born to Healthy Start clients in FY 2003 was 10.5% and showed a reduction to 10.3% in FY 2006 and FY 2007. The figure increased to 10.7% in FY 2008, not meeting the target. During this period, the national LBW rate for African-Americans actually increased from 13.6% in FY 2003 to 14.0% in FY 2006; in 2007 and 2008, a slight decrease in LBW for African- Americans of 13.9% and 13.6%, respectively, was reported. The Healthy Start program will work through the learning collaborative program and other venues to improve the modifiable factors (e.g., tobacco use) associated with LBW.
The FY 2011 and FY 2012 targets of 9.6% reflect the national trend.
12.II.B.1. Increase annually the number of community members (providers and
consumers, residents) participating in infant mortality awareness public health information and education activities.
Each of the Healthy Start projects has committed to reducing disparities in perinatal health and infant mortality by transforming their communities, strengthening community based systems to enhance perinatal care and improving the health of the young women and infants in their
vulnerable communities. This measure demonstrates the participation of community members in infant mortality awareness activities. In FY 2008 the number of community members estimated to participate in public health information and education activities increased to 394,239,
87
exceeding the target of 340,000. The FY 2008 result is up from the FY 2006 actual of 338,800 but down from the FY 2007 result of 391,143. This may be due to changes in service area as mentioned previously. The FY 2012 target is 376,000.
12.E. Increase the number of persons served by the Healthy Start program with a (relatively) constant level of funding.
The program proposes to demonstrate its efficiency by serving more persons each year with a (relatively) constant level of funding. In FY 2008, the number of persons served by the Healthy Start program was 571,167, up from 288,800 in FY 2002 and 542,484 in FY 2007; the FY 2008 result exceeds the target of 475,000. The target for FY 2009 is 485,000 because of expected year-to-year fluctuations. The FY 2010 target is 524,500 and the FY 2011 target is 552,500. The FY 2012 target is 532,500.
88
FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS