Linkage of Montana’s State Selected Priorities with

National Performance and Outcome Measures

Montana’s priority health needs selection was determined from the results of the 5-Year statewide Needs Assessment, and each identified concurrently with relevant performance measures.  Criteria were established from guidance provided by HRSA.  Of the ten priority needs chosen, eight have clear links to National Performance Measures (NPMs).

The following is the rationale for each NPM choice:

NPM 2 – Low-Risk Cesarean Deliveries: reduce number of cesarean deliveries among low-risk first births.

Rationale - The Montana Prenatal Quality Collaborative (MPQC) was created in 2014, to address the DPHHS Director’s priority for reducing Early Elective Deliveries. Birth certificate data for 2008-2012 show approximately 17% of pre-term births annually were the result of induction or cesarean section.

Montana’s State Health Improvement Plan includes the goal to decrease the proportion of pre-term births from 9% to 7% by 2018 through PHSD and DPHHS program strategies.   Also, Montana’s Infant Mortality Collaborative Improvement & Innovation Network (IM CoIIN) team is playing a pivotal role in developing and maintaining public and private organization partnerships, which aim to promote a 39 week gestational period.  IM CoIIN members include: representation from the MPQC and Indian Health Services; the Montana Tobacco Use Prevention Program Coordinator; and the Fetal, Infant, Child and Maternal Mortality Review (FICMMR) Coordinator. 

All mothers who delivered during calendar year 2015 will be asked to complete the Health Survey of Montana’s Mothers and Babies 2015, which is modeled on the CDC Pregnancy Risk Assessment Monitoring System (PRAMS).  The survey is a collaborative effort with the FCHB, Office of Epidemiology and Scientific Support, and Montana HealthCare Foundation.  It will provide additional data on low-risk mothers having cesarean deliveries. This data will also be used for developing and distributing targeted messages, in areas with a greater rate of low-risk cesarean deliveries.

NPM 4 – Breastfeeding: a) percent of infants ever breastfeed and b) percent exclusively through 6 months.

Rationale - There is a large geographic area of Montana without access to a Breastfeeding Peer Counselor, and the amount of infants who are breastfed exclusively through 6 months is only 19.3%.  Increasing breastfeeding rates has a proven health benefit towards helping infants and children to thrive.

WIC has discussed possible ways to expand the BPCP coverage across the state.  NAPA’s Montana Baby Friendly Hospital Initiative includes ten sites working to reach Baby Friendly status. Local WIC agencies near the sites are encouraged to collaborate with them to reach that status. With the assistance of an infrastructure grant, the FCHB is planning to increase the number of Certified Lactation Counselors (CLCs) available as WIC employees, and to address the shortage of such individuals statewide. The grant was developed with the goal of training 20 additional staff.  Priority will be given to local program Breastfeeding Coordinators who have not yet received this training.

The Montana Breastfeeding Peer Counselor Program is working to add another local program in 2016.  If negotiations are successful, an existing program will expand to provide services to a neighboring local agency.  Planning includes providing some services via distance delivery.  Using alternate methods such as phone or iPad will greatly increase outreach.

NPM 5 – Infant Back to Sleep: increase number of infants placed to sleep on backs.

Rationale - Montana is participating in the AMCHP/NICHQ/HRSA sponsored Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN). IM CoIIN members include several from the FCHB, the MT Tobacco Use Prevention Program Coordinator, Indian Health Services, the Medicaid Health Reform Specialist, the Medicaid EPSDT Nurse Consultant, and the FICMMR Program Coordinator.  Safe Sleep is one of the Health Learning Networks that the team is participating in.  The IM CoIIN team will play a pivotal role in developing and maintaining public and private organization partnerships, and promoting the action plans developed for Safe Sleep.

All mothers who deliver during calendar year 2015 will be asked to complete the Health Survey of Montana’s Mothers and Babies, which is modeled on the CDC Pregnancy Risk Assessment Monitoring System (PRAMS).  The survey, a collaborative effort with the FCHB, OESS, and the Montana HealthCare Foundation, will provide additional data on safe sleep practices. Along with data collected by local FICMMR teams, which is entered into the Child Death Review (CDR) Reporting System, it will be used for developing and distributing targeted messages.

The state FICMMR Program Coordinator will be leading a CDR quality improvement initiative, which focuses on 21 CDR Sections that are of critical importance for local teams to accurately complete.  Those sections include sleeping or sleep environment.  The Coordinator will also be implementing a back to sleep program.

NPM 7 – Child Injuries: rate of injury-related hospital admissions per ages 0 – 19 years.

Rationale - Encompasses all causes of injury and death for ages 0-19.  In FY 2015, almost 20% of county public health departments (CPHDs) chose to address unintentional injury as their performance measure, and 51 reported on injury prevention activities. 

The State Health Improvement Plan’s Section D is focused on preventing injuries and exposures to environmental hazards.  The state action plan will reflect strategies from the SHIP and the PHSD Strategic Plan.  These include increasing awareness of injury prevention, implementing evidence-based programs to facilitate injury prevention, and providing training and technical assistance to schools and childcare settings. 

Initial FCHB activity involves the MCH Epidemiologist, who will assess the primary causes of injury-related hospital admissions.  The assessment results will yield information for identifying specific public and private subject matter experts with whom to partner, for creating strategy and outcome measures in a detailed action plan.

NPM 10 – Adolescent Preventive Care: increase number ages 12 – 17 who have annual preventive services visit.

Rationale – Many areas that ranked high as unmet needs on the 5-Year Needs Assessment surveys have to do with adolescent health.  NPM 10 is a way to target many of these that are not covered by other performance measures.  These categories include:  substance abuse, reproductive health and education, mental health, nutrition and weight, and STD/STI prevention and education.

NPM 10 also helps put emphasis on a number of risky adolescent behaviors, some of which are addressed in the SHIP.  Section E. focuses on improving mental health and reducing substance abuse in adolescents and adults.  It includes decreasing the proportion of youth who report using alcohol in the past 30 days from 38% to 34%; decrease the proportion of youth who report having smoked marijuana in the past 30 days from 21% to 18%; and decrease the proportion of youth who report being depressed for 2 or more consecutive weeks in the past 12 months and stopped doing usual activities from 25% to 22%. 

While the PHSD does not have a dedicated adolescent health FTE, various sections have funding for programs that target different aspects of adolescent health.  NPM 10 will help provide a clearinghouse, to gather information and give each program an overall awareness of these different activities.

NPM 13 – Oral Health: a) percent of women who had a dental visit during pregnancy and b) percent ages 1 – 17 with annual preventive dental visit.

Rationale – Oral Health meets the criteria for both geographic and minority health disparities in Montana.  Thirty-four counties have Health Professional Shortages Areas for dental care and the rate of preventive visits for ages 0-17 has stayed constant at about 76.6 percent since 2007.  Also, approximately 6% of Montana’s population is American Indian and this group has a high incidence of dental disease.

Collection of dental sealant surveillance data began in February 2014, in collaboration with the Montana Dental Association, Montana Dental Hygienists’ Association and Sealants for Smiles; through a Basic Screening Survey (BSS) of 3rd grade children.  The Oral Health Program (OHP) Coordinator has continued to develop the oral health surveillance system, and data collection includes the incidence of dental sealants among Medicaid-enrolled children and BSS prevalence data. The data collection will be utilized to foster program evaluation and future planning, and analysis will help to address disparities.

The OHP will continue to build capacity, by increasing the awareness of the impact of oral health on overall health.  Outreach during FY 2015 offered an opportunity to begin collaboration with other Montana DPHHS programs and public health stakeholders, to integrate oral health promotion.  The recently developed Montana Oral Health Surveillance System also includes data on the proportion of Medicaid-enrolled pregnant women that receive dental services.  A communication plan includes outreach to obstetric providers with Centers for Medicare and Medicaid Services print materials to increase the proportion from the FY 2014 baseline of 20%. The OHP will continue to seek additional resources for structured programming focused on pregnant women.

All mothers who delivered during calendar year 2015 will be asked to complete the Health Survey of Montana’s Mothers and Babies 2015, which is modeled on the CDC Pregnancy Risk Assessment Monitoring System (PRAMS).  It will provide additional data on the percent of women who had a dental visit during pregnancy.

NPM 14 – Pregnancy and Household Smoking:  a) percent of women who smoke during pregnancy and b) percent of children living in household where someone smokes

Rationale - High priority area for the PHSD and in the SHIP, with long-term effects over the life course.  In Section A of the SHIP two health indicator goals for 2018 are: 1) Decrease the average consumption of cigarettes in Montana from 58 to 52 packs per person per year, and 2) Decrease the proportion of youth who report they have smoked cigarettes in the past 30 days from 17% to 14%.  An indicator goal in Section B is:  Decrease the proportion of women who report they smoke during pregnancy from 16% to 12%.

Two components of the services that are provided in several home visiting models are tobacco use assessment, and referral to cessation resources as needed. Clients who use tobacco are referred to cessation services if appropriate. The Montana Tobacco Use Prevention Program (MTUPP) is a partner in providing cessation support for pregnant and port-partum women, and provides training as needed.  In 2014, approximately 30% of primary caregivers enrolling in home visiting reported smoking.

All mothers who delivered during calendar year 2015 will be asked to complete the Health Survey of Montana’s Mothers and Babies 2015, which is modeled on the CDC Pregnancy Risk Assessment Monitoring System (PRAMS).  It will provide additional data on the percent of women who smoked during pregnancy.

National Outcome Measures (NOM) which link to Montana’s state selected priorities and National Performance Measure choices are:

         NPM 2 = NOMs 4.1-4.3, 5.1-5.3, 6 and 7

         NPM 4 = NOM 9.5

         NPM 5 = NOMs 9.1-9.3, and 9.5

         NPM 7 = NOMs 15, and 16.1-16.2

         NPM 10 = NOMs 19, and 22.2-22.5

         NPM 12 = NOM 17.2

         NPM 13 = NOMs 14 and19

         NPM 14 = NOMs 2, 4.1-4.3, 5.1-5.3, 6, 8, 9.1-9.5, and 19