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合作改善和创新网络(CoIIN)降低婴儿死亡率:2011 年至 2014 年美国南部的结果评估。

The Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality: An Outcome Evaluation From the US South, 2011 to 2014.

机构信息

Ashley H. Hirai, Reem M. Ghandour, and Vanessa Lee are with the Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. William M. Sappenfield is with the Department of Community and Family Health, University of South Florida, Tampa. At the time of the study, Sara Donahue was with Abt Associates, Cambridge, MA. Michael C. Lu was with the Health Resources and Services Administration, US Department of Health and Human Services, Rockville.

出版信息

Am J Public Health. 2018 Jun;108(6):815-821. doi: 10.2105/AJPH.2018.304371. Epub 2018 Apr 19.

Abstract

OBJECTIVES

To evaluate the impact of the Southern Public Health Regions' (Regions IV and IV) Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, supported by the US Health Resources and Services Administration.

METHODS

We examined pre-post change (2011-2014) for CoIIN strategies with available outcome data from vital records (early elective delivery, smoking) and the Pregnancy Risk Assessment Monitoring System (safe sleep) as well as preterm birth and infant mortality for Regions IV and VI relative to all other regions.

RESULTS

For most outcomes, CoIIN improvements were greater in Regions IV and VI than in other regions. For example, early elective delivery decreased by 22% versus 14% in other regions, smoking cessation during pregnancy increased by 7% versus 2%, and back sleep position increased by 5% versus 2%. Preterm birth decreased by 4%, twice that observed in other regions, but infant mortality reductions did not differ significantly.

CONCLUSIONS

The CoIIN approach to public health improvement shows promise in accelerating progress in intermediate outcomes and preterm birth. Impact on infant mortality may require additional strategies and sustained efforts.

摘要

目的

评估由美国卫生资源和服务管理局(HRSA)支持的南方公共卫生区域(第四和第四区域)合作改进和创新网络(CoIIN)对降低婴儿死亡率的影响。

方法

我们检查了 CoIIN 策略的前后变化(2011-2014 年),这些策略有来自生命记录(早期选择性分娩、吸烟)和妊娠风险评估监测系统(安全睡眠)的可用结果数据,以及与所有其他地区相比,第四和第六区域的早产和婴儿死亡率。

结果

对于大多数结果,CoIIN 在第四和第六区域的改进大于其他区域。例如,早期选择性分娩下降了 22%,而其他地区下降了 14%,怀孕期间戒烟增加了 7%,而其他地区增加了 2%,背部睡眠位置增加了 5%,而其他地区增加了 2%。早产下降了 4%,是其他地区的两倍,但婴儿死亡率的下降没有显著差异。

结论

CoIIN 改善公共卫生的方法在加速中间结果和早产方面显示出了希望。对婴儿死亡率的影响可能需要额外的策略和持续的努力。

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