How one health system targeted social determinants to lower infant mortality disparities
Health systems, researchers and policy-makers have long attempted to reduce infant mortality rates by improving the quality of prenatal care and access to care, but the United States continues to fall behind.
Infant death rates in Detroit have improved in recent years, but the infant death rate for black babies remains twice as high as the rate for white babies.
“We have stellar, high-quality health care systems that are providing cutting-edge care,” said Kimberlydawn Wisdom, M.D., senior vice president of community health and equity at Henry Ford Health System (HFHS) in Detroit. “But when we look at issues related to infant mortality, we still have a problem that in many instances seems intractable.” In response, HFHS helped launch the SewUp the Safety Net for Women and Children program in 2011. The program subsequently was rebranded as the Women-Inspired Neighborhood (WIN) Network: Detroit.
“We pulled together a group of stakeholders that consisted of health systems, local and state health departments, academia, community-based organizations and other key community leaders,” said Wisdom, who also serves as HFHS chief wellness and diversity officer.
The program is the first in the nation to combine the expertise of community health workers with that of certified nurse midwives. This model allows midwives to connect patients with social services and community health worker-based support.
“The issues that cause the disparity in infant mortality between black women and white women constitute a very dynamic problem, and our approach to it was to come up with dynamic solutions that would look at more than just the medical model of addressing it,” said Jaye Clement, HFHS director of community health programs and strategies. “The community health worker was, for us, a solution in that regard, because of their relationships with community stakeholders, partners and residents.”
Midwives were incorporated into the pro-gram because “in their approach to care, mid-wives tend to be more community focused, more focused on educating women about their care,” said Wright Lassiter III, president and CEO of the system. “We believe very strongly that the combination of certified nurse midwives with community health workers creates a very synergistic, collaborative approach to reducing the specter of high infant mortality in the city of Detroit, and particularly in communities of color.”
The WIN Network program includes 10 sessions of group prenatal care instruction, based on the CenteringPregnancy curriculum. In addition, a home-visiting curriculum guide was developed by WIN Network in partnership with a comprehensive team of HFHS clinical, community and research staff.
Participants receive information around social determinants of health as to how to navigate community resources, health literacy, budget management and goal setting. The WIN Network has received more than $4 million in grants since its inception. Original funders included the Robert Wood Johnson Foundation’s Local Funding Partnership, The Kresge Foundation, W.K. Kellogg Foundation, the four major health systems serving Detroit in an unprecedented collaboration, as well as several other foundations. Recent and current funders include the Michigan Health Endowment Fund, March of Dimes Foundation–Michigan Chapter, Rita & Alex Hillman Foundation and the DMC Foundation.
The impact of the WIN Network and enhanced group prenatal care can be seen in immediate birth outcomes, along with wellness indicators assessed during the infant’s first year of life. As of September 2018, 156 eligible women had enrolled in the enhanced group prenatal care program. Among those participants, zero preventable deaths were reported in connection with 114 births for which hospital information was available.
In 2016, 14.5% of babies born in Detroit had a low birthweight and 14% of births were preterm. But of the babies born to WIN Net-work participants that year, only 7% had a low birthweight and only 4.4% were preterm.
“What I look forward to in the future of our program is even greater collaboration beyond Henry Ford and beyond the area we’ve touched thus far, so that we can dramatically impact the overall infant mortality rate of southeast Michigan,” Lassiter said.