The stories beneath the data: early intervention

At Cradle Cincinnati, improving data around pregnancy is absolutely central to our work. This is the first in a series of posts about how data can help drive healthy change for Hamilton County.THE DATA:76% of the babies that died in 2013 were born preterm (less than 37 weeks gestation).THE STORY BENEATH THE DATA:For an infant mortality intervention to have any hope of significant success, it must come early.  Otherwise, it will be too late to help most families that lose a baby. If we want to reduce infant mortality, our entire community must become obsessed with getting every mom support earlier and earlier in her pregnancy. That support can look like prenatal care, but it can also look like social support from one of the many nonprofits that exist to help pregnant moms.  This means:

• We must start measuring the quality of care (both medical and social care), in part, by measuring the gestational age at which that care first reaches mom. Anyone working with pregnant women should know this data point for their program and should be working to lower it. Policy makers should incentivize improvements in gestational age of entry into care.

• We must design interventions that address women’s health before they are even pregnant. The earlier the intervention, the greater the impact. (In fact, that mom who we first reach late in her pregnancy is the perfect candidate to start a conversation with about the health of her possible next pregnancy.)

• We must encourage women to seek care as soon as they find out they are pregnant.  Calling 211 will help connect moms to services and is a great place to start.

 A DEEPER LOOK:This also means that we cannot measure an intervention’s quality by simply measuring its infant mortality rate. It’s a bit counterintuitive, but this is a case where a failure (not reaching mom early enough) can actually look like a success at first glance (a low infant mortality rate).Here’s an example:

• The 2013 infant mortality rate for Hamilton County was 8.9 deaths / 1,000 live births.

• But, about a third of our deaths happened before the 23^rd week of pregnancy. So, if an intervention first reaches mom after that point, it has already missed the chance to help many of the highest risk pregnancies.  In fact, the infant mortality rate for babies born after the 23^rd week in 2013 was only 5.9. An intervention that first reaches mom at that 23^rd week should compare its outcomes to the 5.9 rate and not the 8.9 rate. We’d expect far better results than 8.9 even if the program had little impact.

• Similarly, the rate for all babies born full term (>37 weeks) was 3.3.  Late-term and post-birth interventions should only be compared to the 3.3 rate when measuring their effectiveness.