How Ohio hospitals collaborated to reduce disparities in infant mortality

Nationwide, an estimated 13,000 black infants die each year before their first birthdays, twice the rate of white infants. Ohio’s infant mortality rates (IMR) are some of the highest in the nation. The state ranks 48th in the U.S. for overall IMR and 49th in black IMR.

“Our county was among the worst in Ohio for infant mortality, and the mortality for African American babies was significantly higher,” said Liz Edmunds, DNP, R.N., executive director of population health with Aultman Hospital.

Edward J. Roth III, president and CEO of Aultman Health Foundation, Thomas Cecconi, president and CEO of Mercy Medical Center (retired) and James Adams, health commissioner for Canton City Public Health, knew some- thing had to be done to improve those numbers. In 2013, they met with other local hospital executives, public health officials and community stakeholders to come up with solutions.

“The group was put together in a way that would be collaborative and would work together to make a difference,” Roth said. “Our goal was that every baby in Stark County would have the opportunity to reach [his or her] first birthday.”

This led to the creation of the Stark County Toward Health Resiliency for Infant Vitality and Equity (THRIVE) program, managed on behalf of the Stark County community by Canton City Public Health.

The local hospitals provided initial collaborative funding, and additional funders included the Ohio Department of Medicaid and the March of Dimes.

“We focus on reaching high-risk women, many of whom are African Americans,” said Anne Paliswat, MSN, R.N., vice president of nursing professional practice and advocacy with Aultman Hospital. “THRIVE promotes women’s health before, during and after pregnancy. We have developed local partnerships to address the health needs of women of child-bearing age in our community.”

After conducting a fetal infant-mortality review, the collaborating stakeholders selected interventions that would have the greatest possible impact on overall infant mortality and the disparity between the white and black IMR.

For example, THRIVE offers a program known as CenteringPregnancy that provides group prenatal care and community-based care coordination. The goals include raising awareness of the value of early prenatal care, linking women to prenatal services, addressing barriers to prenatal care and meeting socio-economic needs.

Another THRIVE initiative focuses on safe sleep education, policies and resources to staunch the problem of infants dying at home because of unsafe sleeping conditions.

“I’ve been very excited to work with our county health department in a program called Cribs for Kids,” Paliswat said. “When we identify a family that doesn’t have a safe sleep place for their infant, we give them a Pack ‘n’ Play bassinet. This is a joint community effort, so the other area hospitals also are offering this service.”

Such interventions “extend our reach outside the hospital to tackle social determinants,” Edmunds said.
   
Other collaborative partners in THRIVE include local school districts, community health providers and faith-based groups.

Statistics indicate that THRIVE has made a positive impact. “The white infant mortality rate in 2012 was 8.5 (per 1,000 live births),” Edmunds said. “In 2018, it was down to 5.8. More significantly, the black infant mortality rate in 2012 was 19.7, and it has been reduced to 7.4.”

Other positive results include a 10% increase in the number of pregnant black women in Stark County who entered prenatal care during their first trimester between 2015 and 2016.

“We have the resources necessary to make this a sustainable, ongoing program,” Roth said. “Our collaboration is a collaboration of our entire community. And while we’re very pleased with our success so far, we know that the job isn’t over, and we’ll continue to work together so that every baby in the community has the opportunity to reach his or her first birthday.”