PCCI Pediatrician: The U.S. preterm birth rate is troubling, but we have proven ways we can help bring pregnancies to term

By Yolande Pengetnze, MD, MS, FAAP, Vice President of Clinical Leadership, PCCI

Recently, the March of Dimes (MOD) released its report card (https://www.marchofdimes.org/peristats/reports/united-states/report-card) that highlights the latest key indicators describing the state of the nation’s maternal and infant health. The MOD gave the U.S. a near failing, D+ grade for its 10.5 percent preterm birthrate.

The rising U.S. preterm birth rate is partly explained by racial/ethnic disparities, with Black women having ~50% higher risk of preterm birth than White women. The single most important intervention to prevent preterm births is adequate prenatal care. Yet one in 5 pregnant Black women and 1 in 4 pregnant American Indian/Alaska Native women do not receive adequate prenatal care.

The high U.S. preterm birth rate, while concerning, can be reduced by closing racial/ethnic and socioeconomic gaps in care through programs that increase access to prenatal care and address non-medical determinants of health (NMDOH, also known as Social Determinants of Health or SDoH). Moreover, widening racial/ethnic disparities in maternal death are partially explained by the same factors that drive preterm birth risk. Therefore, addressing preterm birth risk in a holistic manner has the added benefit of potentially (and positively) impacting maternal mortality.

At PCCI, we’ve developed ways to identify and support at-risk pregnant women in bringing their pregnancies to term. Specifically, to better serve pregnant women in our community, PCCI, the Parkland Community Health Plan (PCHP) and Parkland Health developed and implemented, beginning in 2018,  a novel preterm birth prevention program  that uses a machine learning algorithm, healthcare data, and SDoH to identify pregnant women who are at a higher risk of pre-term birth. The program engages these women through text messages designed to help them better manage their health and proactively seek care during pregnancy.

Our program consistently risk stratifies about 13,000 pregnant women per year by combining clinical, socioeconomic, and demographic indicators from diverse data sources to predict pregnant women who present a high risk for preterm delivery. By predicting preterm birth accurately and in a timely manner, we are able to target patient education and engagement, as well as clinical and population-level interventions to reduce preterm birth rates among low-income Medicaid patients.

As socioeconomic factors and psychosocial stress are increasingly recognized as important drivers of preterm birth risk, PCCI’s risk prediction model paves the way for novel approaches to preterm birth prevention, combining clinical and non-traditional preterm birth prevention interventions addressing NMDOH targeted to high-risk patients.

This ongoing program enables early interventions, including enrolling women in a text education and reminder program that has helped reduce preterm birth rates by 20 percent and has increased prenatal doctor visits by 8-15 percent.

The combination of technology― a predictive model that identifies the most at risk and a risk-driven text messaging program―efficiently reaches expectant mothers where they are in their pregnancy journey. Rather than simply throwing out a broad net for all pregnant women, through our examination of NMDOH elements, we gain a clearer picture of who we need to help and why. This makes interventions much more holistic, effective, and cost efficient.

Through trial and error, we found that simple texting was the best way to reach expectant mothers and provide positive and easy-to-understand messages and reminders to help them to reach term. Examples of texts include:

This innovative yet simple approach for participant management allows us to extend great resources and focus on those who need help the most. In fact, in our quarterly surveys of the program participants, an average of 73% of respondents have agreed this program made them better prepared to take care of themselves and their babies. These results are meaningful not just to the mother and her family, but to the entire community.

It is extremely important to emphasize that while the program itself is innovative, it can be scaled and utilized in just about any community. Preterm birth  is not an issue that we want to simply shrug our shoulders about. Each time we have a premature birth, the costs to the baby, parents, hospital, and ultimately the community can be enormous. The life of a premature baby can be one of hardship and challenge and create lifelong difficulties for the individual, their family, and the society at large. Our collaborative team behind our preterm birth prevention program passionately believes that any preterm birth that can be prevented is a chance for a life to flourish and make a difference in the world.

About Yolande Pengetnze

Yolande Pengetnze, MD, MS, FAAP, is PCCI’s Vice President of Clinical Leadership where she leads multiple projects including population health quality improvement projects focusing on preterm birth prevention and pediatric asthma at the individual and the population level. Dr. Pengetnze received her MD from the University of Yaounde in Cameroon and completed a Pediatric Residency at Maimonides Medical Center in New York. She was a faculty member at UTSW’s General Pediatric Hospitalist Division where she completed a General Pediatric/Health Services Research Fellowship training and earned a Master of Sciences in Clinical Sciences.

News: Interactive dashboard spotlights Dallas County communities with high asthma rates

Interactive dashboard spotlights Dallas County communities with high asthma rates

Parkland, PCCI, DCHHS partner to provide insights for child caregivers

DALLAS –Parkland Health and Dallas County Health and Human Services (DCHHS) in collaboration with Parkland Center for Clinical Innovation (PCCI) launched a new Pediatric Asthma Surveillance System (PASS)* that describes community-level information regarding pediatric asthma risk factors in Dallas County.

The interactive dashboard was developed as part of the pediatric asthma initiative through the Dallas County Community Health Needs Assessment. The overall goal of this surveillance system is to provide current and accurate data to stakeholders interested in planning, developing and deploying pediatric asthma interventions, programs and policy; with this in mind, PASS data sets will be updated regularly hereafter.

“The Pediatric Asthma Surveillance System provides valuable key insights into pediatric asthma vulnerability and the associated clinical, demographic, environmental and social/economic drivers. Being able to drill down to neighborhoods and specific census tracts will provide public health leaders and agencies with data they need to address health disparities in the community and improve pediatric asthma for all,” said Steve Miff, PhD, PCCI’s President.

PASS includes a novel, validated Pediatric Asthma Vulnerability Index, that integrates health and social data insights to identify communities where children have higher vulnerability to poor asthma outcomes and highlight areas of health disparities. It can also predict the probability of a community-level asthma-related emergency department (ED) visit or hospitalization within three months, by incorporating the effect of 10 community indicators such as socioeconomic conditions, demographic characteristics, medication use patterns, health services utilization and environmental conditions, on community-level asthma risk.

“We plan on using the data from PASS to help us strategize outreach into the community,” said Cesar Termulo, MD, Pediatrician and Associate Medical Director at Parkland. “There are many children who might not be aware that they have asthma. They might solely be having a chronic cough or shortness of breath with exercise. Thus, it is important to find those pockets of Dallas County that might have a higher vulnerability to asthma attacks and raise awareness in the community to diagnose those children who have unrecognized asthma.”

At every geographic level, a risk-driven, color-coded map is displayed in the center with demographic data included below the map. The Vulnerability Index and all indicators are categorized as Very High, High, Moderate, Low or Very Low Risk based on their impact on Pediatric Asthma Vulnerability in the community. The user can drill down from the Vulnerability Index view to specific indicator views by clicking on specific indicators of interest or navigating to the “Other Indicators” tab. The user can also navigate the map from a ZIP Code view to a Census Tract view to further analyze microgeographic disparities and can select a specific geography of interest for further analysis.

The PASS is also meant to support Parkland and DCHHS efforts in reducing poor health outcomes related to pediatric asthma and will be used to outreach and engage parents or caregivers to participate in Parkland’s pediatric asthma text notification. Parkland’s asthma text message program is an interactive tool designed to help parents manage their child’s asthma. Parents can sign up by texting @asthma to 844-721-0839 (except for message/data rates, the text program is free to eligible patients). To learn more about the asthma text program, visit, www.parklandhealth.org/asthma-in-children.
Programs like these are made possible thanks to generous donors who help support our patients. If you want to support the program you can do so, at Ways to Give – Donate – Parkland Health Foundation (istandforparkland.org).

For more information about Parkland, visit www.parklandhealth.org.
For more information about PCCI, visit www.pccinnocation.org.

To view the dashboard go to: https://www.dallascounty.org/departments/dchhs/chronic-disease/asthma-control-overview.php

About Parkland Center for Clinical Innovation
Parkland Center for Clinical Innovation (PCCI), founded in 2012, is a not-for-profit, healthcare innovation organization affiliated with Parkland Health. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations.

*This work is funded in part by Lyda Hill Philanthropies.

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In The News: FierceHealthcare – How providers Parkland is supporting at-risk mothers using a device already in their pockets

FierceHealthcare, a top national healthcare trade publication, has published an article that includes PCCI experts discussing our preterm birth prevention program. The article, “How providers like UAB, Parkland Hospital are supporting at-risk mothers using a device already in their pockets” includes quotes from Dr. Yolande Pengetnze. Read the whole story here: https://www.fiercehealthcare.com/digital-health/providers-utilize-sms-text-messages-tackle-continuing-maternal-health-crisis

Here are highlights of the article:

Parkland Center for Clinical Innovation (PCCI) and Parkland Hospital in Dallas developed their own program enrolling at-risk patients in a text reminder program. The program’s main goal is decreasing preterm delivery in at-risk pregnant patients. PCCI determined which patients to enroll by using social determinants of health data.

Text messages varied from reminders to arrive at appointments with a list of questions, to take prenatal vitamins and to place seatbelts over the hips instead of the belly. Text reminders changed as patients progressed through pregnancy with notifications in the third month of pregnancy from informing parents that their baby was the size of a peach, to late-term reminders directing patients to ask their doctor about early signs of labor.

PCCI screened 13,000 women for social determinants of health, hypertension, diabetes and mental health risks. Of the enrolled women, preterm delivery decreased by 20%, prenatal doctor visits increased by 8% and costs decreased by 6%.

Yolande Pengetnze, M.D., a pediatrics specialist and program manager of the preterm prevention program, told Fierce Healthcare that 85% of participants preferred texts when receiving prenatal healthcare advice and 74% said the program made them better prepared for parenthood. “We needed a solution that patients could use with one hand because they have a baby in the other,” Pengetnze said.

“A lot of confusing and conflicting information is communicated on social media and that is where patients are going for advice,” Pengetnze said. “The social fabric has changed and people don’t have the same at-home support as they once did. New parents need all sorts of advice from how to feed their baby to what to ask their doctor.”

 

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The Scope Podcast: PCCI’s Steve Miff on healthcare data and technology

PCCI’s CEO, Steve Miff, joined The Scope podcast where they discuss:

  • A deeper dive into Steve’s position that in order to effectively deploy value-based care and sustain it, we have to focus on health in addition to healthcare.
  • Identifying the first steps organizations need to take to begin building out healthcare data analytics and social infrastructure, and what the biggest challenges are along that path.
  • How data can be leveraged for the social determinants of health?
  • When will organizations move beyond population-level social determinant data and move into personalized referrals?
  • What excites Steve about the future of healthcare and specifically value-based care?
  • What is on the horizon at PCCI in this time of change in healthcare?

 

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PCCI seeking Sachs Summer Scholar Candidates

PCCI currently is seeking candidates for the upcoming term of its Sachs Summer Scholars. Focusing on offering opportunities for women, the PCCI Sachs Summer Scholars is one of North Texas’ most prestigious internship programs as it immerses students in the world of healthcare technology and science.

Click here to watch a view where 2022 Sachs Summer Scholars share their experiences:  https://www.youtube.com/watch?v=h7e4tnoaZdc

Whether your abilities are in data science, technology, research, engineering, project management or one of the many other areas of healthcare administration and support, everyone at PCCI works together to fulfill our mission: pioneering new ways to health. By joining PCCI, you become part of a diverse healthcare legacy that’s served our community for more than 10 years.

Primary Purpose

Advance the representation of women in Data Science and Technology to promote practical applications of analytics, computing and data science. Assists with special projects and research including technology and analytics in healthcare, in order to gain business knowledge and research experience.

Minimum Specifications

Education

  • Must be enrolled in a related Bachelor’s degree program at an accredited university, with a minimum of 30 credit hours OR Be a recent college graduate with a four year degree OR Be a current graduate / doctoral student.

Experience

  • Worked or currently working on projects related to Natural Language Processing, Artificial Intelligence, Machine Learning, computer vision, image analysis, geocoding, computer science or relevant engineering specializations.

Equivalent Education and/or Experience

  • May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.

Skills or Special Abilities:

  • Must be computer literate, with basic knowledge of word processing, spreadsheet, and/or database software.
  • Excellent problem solving skills; flexible and resourceful to efficiently and effectively meet objectives.
  • Must be able to demonstrate exceptional critical thinking skills to solve challenging advanced analytics problems and provide solid solutions.
  • Excellent verbal and written communication skills; ability to write and communicate effectively to diverse audiences; presents and represents varying views and perspectives effectively.
  • Must be flexible and be able to prioritize and reprioritize projects in line with PCCI leaders to meet deadline and deliverables.
  • Must demonstrate exceptional abilities for high level comprehension of projects and environment as well as remain extremely detail oriented for tasks and responsibilities.
  • Must be independent and reliable with the ability to drive initiatives to completion.
  • A successful history of working collaboratively on research projects and the ability to work productively as either a leader or member in reaching shared objectives.
  • Knowledge of clinical informatics and health care settings.
  • Must have strong analytic and computer skills in addition to knowledge of database management and data analysis.
  • Demonstrate Natural Language Processing, Artificial Intelligence, or Machine Learning skills utilizing any computer software.
  • Must be able to demonstrate a working knowledge of program evaluation methods, research skills, management information systems, and strategic planning.
  • Highly familiar with database theory, applications, and management systems.
  • Must be able to demonstrate a working knowledge of statistical methods & analysis, concepts, practices, and procedures.
  • Research and development in areas of predictive modeling, data mining & management, and other advanced analytics in the development of business intelligence and technology transfer.
  • Must have working knowledge in advanced data programming language and statistical analysis software. (be able to program in R, Python, Unitex, Lexigram, STATA, SPSS, or SAS statistical software).
  • Working knowledge in the following methodologies: risk adjustment, time series analysis, recursive partitioning, quantile regression, boot strapping, instrumental variable analysis, Cox proportional hazard models, dynamic Bayesian and machine learning algorithms, Monte Carlo simulations, or neural networks.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Apply here: https://www.parklandcareers.com/job/Dallas-PCCI-Sachs-Sum-Scholar-Intern-TX-75201/978161000/

VIDEO: PCCI Releases 2022 Annual Impact Report PCCI’s CEO, Steve Miff, introduces the PCCI 2022 Annual Impact Report

Steve Miff, introduces the PCCI 2022 Annual Impact Report:

 

PCCI’s 2022 Annual Impact Report Released

PCCI has released its 2022 Annual Impact Report virtually. PCCI’s 2022 Annual Impact Report outlines PCCI’s efforts over the past year to help support those most in need in our communities.

The report includes insights into PCCI’s innovations including PCCI’s efforts to fight COVID-19 in Dallas the conclusion of the Accountable Health Communities Model in Dallas County, pediatric asthma mitigation, preterm birth prevention and much more.

Click here for the online Flipbook version of the report: PCCI 2022 Annual Impact Report – Flipbook

Or click here to download the PDF version of the report: PCCI 2022 Annual Impact Report PDF

To send a comment, question or greeting to PCCI’s CEO, Steve Miff, PhD., please email him at: pcci.ceo@pccinnovation.org

 

BMJ Journals: 5 Methods and tools for situational awareness and equitable decision-making during COVID-19

Read a presentation abstract, co-authored by PCCI’s Steve Miff, that highlights the evolution of PCCI’s COVID-19 vulnerability index to the nationwide Community Protection Index.

Abstract
Background The COVID-19 pandemic has highlighted the critical and ongoing need for leaders across health care, public health, and government to have real-time, hyper-local data. These data need to be relevant and meaningful across multiple sectors. Moreover, data are most likely to be useful when they facilitate connections across systems, enable situational awareness, and drive equitable decision making.

Other authors of the presentation include members from the Institute for Healthcare Improvement, PCCI, Cincinnati Children’s Hospital and University of Cincinnati College of Medicine, and Civitas Networks for Health.

https://bmjopenquality.bmj.com/content/11/Suppl_3/A7.1#article-bottom

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KERA NEWS: Childhood asthma seeing some improvement, Dallas County hospital says

Dr. Yolande Pengetnze

KERA News is reporting that from June 2020 to May 2022, there were 36% fewer emergency department visits for asthma among children in the program, compared to children with similar asthma risk whose families did not get the texts.

“Asthma is a lifelong disease,” Dr. Yolande Pengetnze of PCCI told KERA. “However, it is controllable. And once it’s controlled, you can lead a normal life without having to think about asthma.”

https://www.keranews.org/health-wellness/2022-12-29/childhood-asthma-seeing-some-improvement-dallas-county-hospital-says