Infant Mortality Research Partnership

Overview

Starting in 2016, the Ohio Department of Medicaid (ODM) and the Ohio Department of Higher Education (ODHE) jointly sponsored and funded the Infant Mortality Research Partnership (IMRP), in recognition of the State’s need for rigorous research to identify interventions and resources to improve health outcomes for underserved populations and address this complicated health issue.

Over four phases of the project, experts from The Ohio State University’s Colleges of Medicine and Public Health, with the Ohio Colleges of Medicine Government Resource Center (GRC), created:

  1. 16 predictive models for infant mortality (IM), preterm birth (PTB), and severe maternal morbidity (SMM)
  2. An infant mortality and pre-term birth Risk Calculator for use in shared decision making by practitioners and patients at the point of care
  3. A geospatial analytics tool to be used by state agencies and local communities to target resources and services toward this vital health issue
  4. The Medicaid Perinatal Risk Toolkit (MPRT) which includes the IM, PTB, and SMM Risk Calculators and EHR-connected Pregnancy Risk Assessment Form (PRAF-EHR).

The Risk Calculator estimates the likelihood of preterm birth and infant mortality and produces relative risk scores for pregnant individuals at the point of care to encourage clinicians to recognize and direct high-risk individuals to appropriate medical and community resources. In the next year, the tool will also include a severe maternal morbidity risk calculator. The Risk Calculator was created as part of a research partnership and includes a retrospectively validated risk model using demographic and medical history data. It requires little manual data entry. The Risk Calculator has been integrated with the Epic-EHR at the OSUWMC and a clinical trial is currently underway to understand how the tool can best be used in clinical practice.

The PRAF-EHR allows providers to extract many of the required fields in the PRAF 2.0 without manual data entry and seamlessly transmit the data to the appropriate entities. The PRAF-EHR is estimated to reduce the time required for a user to submit a PRAF.

The IMRP Project Spans Five Phases

  • Phase I of the IMRP (2016-2017), which leveraged a diverse array of data and methods, sought to answer three overarching questions:
    This work involved subject matter experts from multiple academic institutions and other agencies including the Ohio Department of Job and Family Services, Mid-Ohio Foodbank, OSU Wexner Medical Center, Case Western Reserve University, Kent State University, University of Cincinnati, and Wright State University.
    1. Where, within Ohio, should interventions be targeted to reduce infant mortality?
    2. To whom should those interventions be targeted (i.e., which women are at highest risk)?
    3. How should those interventions be implemented, and what will be the likely future impact of these interventions?
  • Phase II (2018-2019), focused on development of predictive models and geospatial analytics, especially focusing on factors that increase risk, such as those related to social and behavioral health or structural and institutional factors. GRC continued to provide project management, data, analytical, infrastructure, and evaluation support to the Partnership’s efforts.
  • In Phase III (2020-present), the project team has worked closely with Information Technology experts and other stakeholders to operationalize the findings of the previous phases. This involved the expansion of the IMRP Web-Mapping Tool and creation of the IM and PTB Risk Calculator, a patient-facing mobile application, and the Curated Ohio Resource Database. Phase III continues with the integration of the PRAF-EHR into MPRT and the spread of the tool across hospital systems across Ohio.
  • IV (2022-present), extends the work completed in the previous IMRP phases by taking the models and tools that have been developed and, through continued rigorous research and evaluation, expanding their reach to more hospital systems. The IMRP team will refine the clinical Risk Calculator and incorporate the SMM models into the tool and create a patient-friendly version of the risk calculators to be used in shared decision making.
  • Phase V (2023-2025), builds on the work of phases I-IV of the IMRP and includes development of new predictive models for the postpartum time period, including postpartum visit, treatment for opioid dependence, depression, maternal morbidity in MPRT. These models will be incorporated into MPRT for use in the clinic setting and to efficiently transmit risk factor information particular to the models to support referral and care coordination.