A 'Moonshot' for Child Health

Each year, more than 20,000 infants die in the U.S. before their first birthday – a seemingly intractable toll that has left the nation ranked 25th among industrialized countries in infant deaths.

In 2012, following a conference in New Orleans, 13 hard-hit states – including most of those in the Deep South -- decided to do something about it.

Together with the March of Dimes, the CDC and other state, federal and local agencies and non-profits – including the Association of Maternal and Child Health Programs and the Association of State Health Officials -- they joined an ambitious and largely untested idea put forth by HRSA’s Maternal and Child Health Bureau:

What if groups of states, using a common data hub, cooperated on a kind of “crash” testing program to try out novel approaches to reducing infant deaths? Thus was born the Collaborative Improvement and Innovation Network – or CoIIN.

Members of HRSA's COIIN Team (from L-R): CDR Maria Benke, EdD, MPH, CHES;<br /><br />
Michael Lu, MD, MPH; Reem Ghandour, DrPH, MPA; Vanessa Lee, MPH.
Members of HRSA's CoIIN Team (from L-R): CDR Maria Benke, EdD, MPH, CHES;
Michael Lu, MD, MPH; Reem Ghandour, DrPH, MPA; Vanessa Lee, MPH.

 

Four years later, said MCHB Associate Administrator Dr. Michael Lu in a June 22 All-Hands webcast, states are clamoring to be part of the “moonshot” program that today hosts intensive, 18-month, multi-state collaborations on a host of childhood health issues.

Said MCHB’s Vanessa Lee: “I think we assume states are working together, or at least working collaboratively. But prior to CoIIN, from what we’ve heard, having that accountability to each other as part of a team working on a common aim, I think, had not happened before.”

CoIIN, she said, is “like collaboration on steroids."

In little more than a year, the infant mortality project helped produce a 12 percent decline in smoking during pregnancy across the South – as 18,000 expectant mothers quit – and a 30 percent reduction in early, elective deliveries.  There were 85,000 fewer such procedures across 13 states.

“Early elective delivery is an issue that costs this nation over a billion dollars each year in preventable medical cost,” Lu said.

“If we could replicate this result nationwide … we can save hundreds of millions of dollars on this one issue alone,” in addition to reducing early developmental delays and mortality among infants.

Graph showing how the infant mortality project helped produce a 12 percent decline in smoking during pregnancy across the South – as 18,000 expectant mothers quit – and a 30 percent reductionin early, elective deliveries. There were 85,000 fewer such procedures across 13 states
In little more than a year, the infant mortality project helped produce a 12 percent decline in smoking
during pregnancy  across the South – as 18,000 expectant mothers quit – and a 30 percent reduction
in early, elective deliveries. There were 85,000 fewer such procedures across 13 states

 

The power of the initiative, said MCHB’s Reem Ghandour, is that state’s agree to “share real-time data” in a secure, internet-based site. The information is then available to dozens of participating experts “across state lines” to “identify problems they have in common” and collaborate on quality improvement strategies.

Final data “normally might not be available for a year or two,” so provisional data is shared securely within the CoIIN group, said Ashley Hirai. “It’s really timeliness that’s most essential for quality improvement. Data just needs to be ‘good enough’ and available for that cycle.”

“It has really promoted a cultural shift in many state health departments – from being health historians waiting years for data” to analysts able to make immediate recommendations for changes in practices.

It also engenders a spirit of open discovery and adoption of “things that work.”

“Seeing data improvement in neighbor states can be a powerful incentive to take action,” Hirai said.  “If Tennessee can do this, we can do this. It can be a powerful motivator.”

Read an overview of CoIIN projects.

Read more about the Infant Mortality CoIIN.

 

 

 

Date Last Reviewed:  April 2017