2.1 What is the Community Vital Signs Project?
2.1 What is the Community
Vital Signs Project?
ERASE-MM Community Vital Signs Projectwww.erase-mm-cvsproject.org
1. Pregnancy-related mortality remains unacceptably high in
the U.S.
Source: PMSS;
https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
2. Black and American Indian/Alaska Native pregnant people
bear substantially greater burden
Source: Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb
Mortal Wkly Rep. 2019 Sep 6;68(35):762–5.
Image source:
https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
3. Pregnancy related mortality varies by geography
Merkt PT, Kramer MR, Goodman DA, et al. Urban-rural differences in pregnancy-related deaths, United States, 2011–2016.
American Journal of Obstetrics and Gynecology
. Published online
February 2021:S0002937821001447.
4. Absolute rates and racial disparities are not constant but
vary by geography
Source: Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb
Mortal Wkly Rep. 2019 Sep 6;68(35):762–5.
Image source:
https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
Magnan, S. 2017. Social Determinants of Health
101 for Health Care: Five Plus Five.
NAM
Perspectives
. Discussion Paper, National
Academy of Medicine, Washington,
DC.
https://doi.org/10.31478/201710c
Modifiable determinants of health
“
Although there is little doubt that genetics and lifestyle
play an important role in shaping the overall health of
individuals, interdisciplinary researchers have demonstrated
how the
conditions in the environment in which people are
born, live, work, age, and play equally as important a role in
shaping health outcomes
”
Maternal Mortality Review Committee
1.
Was the death pregnancy related?
2.
What was the cause of death?
3.
Was the death preventable?
4.
What were the factors contributing to this death?
5.
What are the recommendations to address contributing factors?
6.
What is the anticipated impact of those actions if implemented?
Maternal Mortality Review Committee
1.
Was the death pregnancy related?
2.
What was the cause of death?
3.
Was the death preventable?
4.
What were the
factors contributing
to this death?
5.
What are the
recommendations
to address contributing factors?
6.
What is the anticipated impact of those actions if implemented?
Distribution of
contributing factors
for
pregnancy related deaths
Report
from nine maternal mortality review committees, 2018
Distribution of
contributing factors
for
pregnancy related deaths
Report
from nine maternal mortality review committees, 2018
Why so few community level contributing
factors in MMRC reports?
1.
Community is not a contributing factor (in the opinion of MMRC
members).
2.
There is not data on which to attribute community factors.
3.
Making recommendations regarding community factors is outside
the scope of MMRCs
Changing the conversation:
ERASE-MM Community Vital Signs Project
Provide Data
Link to action
Evidence-based
conceptual model
Changing the conversation:
ERASE-MM Community Vital Signs Project
Provide Data
Link to action
Evidence-based
conceptual model
Changing the conversation:
ERASE-MM Community Vital Signs Project
Provide Data
Link to action
Evidence-based
conceptual model
Changing the conversation:
ERASE-MM Community Vital Signs Project
Provide Data
Link to action
Evidence-based
conceptual model
Layers of information inform the MMRC case
narrative
Conclusion
1.
Understanding and ultimately eliminating racial, economic, and
geographic disparities in maternal mortality require enhanced
review from MMRCs
2.
Community Vital Signs project aims to support MMRCs by…
a)
Developing a framework for understanding multi-leveled drivers of
pregnancy related mortality
b)
Provide visual summaries of data indicators of the “community vital signs”
of the place in which the decedent lived, worked, and played
c)
Provide support for making recommendations tied to the “community vital
signs”
Emory Team
•
Michael Kramer (PI)
•
Sarah Blake
•
Autumn Watson
•
Marissa Coloske
CDC Team
•
David Goodman
•
Julie Zaharatos
•
Toby Merkt
Acknowledgements
Please use the Contact link at
https://erase-mm-cvsproject.org
to
provide any feedback or ask questions
This presentation was prepared by Michael
Kramer
The Community Vital Signs Project was developed by a team at Emory University with support from
Centers for Disease Control and Prevention, Division of Reproductive Health Maternal Mortality
Prevention Team
• Welcome to “technical assistance” for using the Community Vital Signs project resources for Maternal Mortality Review Committees.
• The objective of this presentation is to provide a brief rationale for the development of the Community Vital Signs project and how it is designed to facilitate conversations in state and local Maternal Mortality Review Committees. In addition to this presentation there are several others “learning pathways” and “modules” on the ERASE-MM CVS Project website that address specific aspects of the Community Vital Signs
The Community Vital Signs Project, part of ERASE-MM, aims to tackle inequities in pregnancy-related mortality by providing data dashboards and recommendations. It highlights the disparities faced by Black and American Indian/Alaska Native pregnant individuals and how mortality rates vary by geography and race. By examining modifiable determinants of health, the project seeks to address the high rates of pregnancy-related deaths in the U.S.
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Presentation Transcript
2.1 What is the Community Vital Signs Project? ERASE-MM Community Vital Signs Project www.erase-mm-cvsproject.org
Pathway 1. MMRC Readiness Document # Document title 1.1 1.2 Is your MMRC ready to discuss health equity? Readiness checklist 2. Overview of the Community Vital Signs Project 2.1 2.2 What is the Community Vital Signs project? What causes inequities in pregnancy related mortality? 3. Using the CVS Dashboards 3.1 3.2 3.3 3.4 Understanding the data in the CVS dashboard Interpreting the CVS dashboard CVS Dashboard Cheat Sheet Retrieving CVS dashboards 4. Using the CVS Recommendations Reference 4.1 4.2 4.3 4.4 4.5 Using the CVS Recommendations Reference Overview of CVS Recommendation Reference Recommendation reference document, Part 1 (word) Recommendation reference detail table, Part 2 (excel) RWJF County Health Rankings Roadmap and Recommendations 5. For abstractors 5.1 5.2 Using the CVS dashboard for preparing case narratives Narrative template
1. Pregnancy-related mortality remains unacceptably high in the U.S. Source: PMSS; https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
2. Black and American Indian/Alaska Native pregnant people bear substantially greater burden Source: Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths United States, 2007 2016. MMWR Morb Mortal Wkly Rep. 2019 Sep 6;68(35):762 5. Image source: https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
3. Pregnancy related mortality varies by geography 23.8 19.8 16.2 16.2 14.6 Large Metro Medium Metro Small Metro Micropolitan Noncore Urban Rural Merkt PT, Kramer MR, Goodman DA, et al. Urban-rural differences in pregnancy-related deaths, United States, 2011 2016. American Journal of Obstetrics and Gynecology. Published online February 2021:S0002937821001447.
4. Absolute rates and racial disparities are not constant but vary by geography Source: Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths United States, 2007 2016. MMWR Morb Mortal Wkly Rep. 2019 Sep 6;68(35):762 5. Image source: https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
Modifiable determinants of health Magnan, S. 2017. Social Determinants of Health 101 for Health Care: Five Plus Five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201710c
Although there is little doubt that genetics and lifestyle play an important role in shaping the overall health of individuals, interdisciplinary researchers have demonstrated how the conditions in the environment in which people are born, live, work, age, and play equally as important a role in shaping health outcomes
Maternal Mortality Review Committee 1. Was the death pregnancy related? 2. What was the cause of death? 3. Was the death preventable? 4. What were the factors contributing to this death? 5. What are the recommendations to address contributing factors? 6. What is the anticipated impact of those actions if implemented?
Maternal Mortality Review Committee 1. Was the death pregnancy related? 2. What was the cause of death? 3. Was the death preventable? 4. What were the factors contributing to this death? 5. What are the recommendations to address contributing factors? 6. What is the anticipated impact of those actions if implemented?
Distribution of contributing factors for pregnancy related deaths 45 38.2 40 33.9 35 30 25 21.6 % 20 15 10 4.4 5 1.9 0 Patient/Family Provider Facility Systems of care Community Report from nine maternal mortality review committees, 2018
Distribution of contributing factors for pregnancy related deaths 45 Patient level factors Provider level factors Facility level factors Systems level factors Community level factors? 38.2 40 33.9 35 30 25 21.6 % 20 15 10 4.4 5 1.9 0 Patient/Family Provider Facility Systems of care Community Report from nine maternal mortality review committees, 2018
Why so few community level contributing factors in MMRC reports? 1. Community is not a contributing factor (in the opinion of MMRC members). 2. There is not data on which to attribute community factors. 3. Making recommendations regarding community factors is outside the scope of MMRCs
Changing the conversation: ERASE-MM Community Vital Signs Project What are some causes of inequity? Socio-spatial data indicators CVS CVS Dashboard Recommendation Evidence-based conceptual model Provide Data Link to action
Changing the conversation: ERASE-MM Community Vital Signs Project What are some causes of inequity? Socio-spatial data indicators CVS CVS Dashboard Recommendation Evidence-based conceptual model Provide Data Link to action
Changing the conversation: ERASE-MM Community Vital Signs Project What are some causes of inequity? Socio-spatial data indicators CVS CVS Dashboard Recommendation Evidence-based conceptual model Provide Data Link to action
Changing the conversation: ERASE-MM Community Vital Signs Project What are some causes of inequity? Socio-spatial data indicators CVS CVS Dashboard Recommendation Evidence-based conceptual model Provide Data Link to action
Layers of information inform the MMRC case narrative Social context Prenatal Informant interviews Delivery + PP Community vital signs dashboard Prenatal care ER/Hospitalizations Delivery hospitalization Mental Health ER/Hospitalizations Other Office Visits Mental Health Social & Environmental Profile Other Office Visits Social & Environmental Profile
Conclusion 1. Understanding and ultimately eliminating racial, economic, and geographic disparities in maternal mortality require enhanced review from MMRCs 2. Community Vital Signs project aims to support MMRCs by a) Developing a framework for understanding multi-leveled drivers of pregnancy related mortality b) Provide visual summaries of data indicators of the community vital signs of the place in which the decedent lived, worked, and played c) Provide support for making recommendations tied to the community vital signs
Acknowledgements The Community Vital Signs Project was developed by a team at Emory University with support from Centers for Disease Control and Prevention, Division of Reproductive Health Maternal Mortality Prevention Team Emory Team Michael Kramer (PI) Sarah Blake Autumn Watson Marissa Coloske CDC Team David Goodman Julie Zaharatos Toby Merkt Please use the Contact link at https://erase-mm-cvsproject.org to provide any feedback or ask questions This presentation was prepared by Michael Kramer
