Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality: Regions IV and VI Results

Background: Launched in the 13 Regions IV/VI states in 2012, the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality is a public-private partnership using the science of quality improvement and collaborative learning to achieve aims in common priority areas.  We examined progress toward shared goals: reducing early elective delivery and promoting smoking cessation, safe sleep, perinatal regionalization, and interconception care.

Methods:  Regions IV/VI CoIIN outcomes are measured using vital statistics, Medicaid, and PRAMS data. We reviewed outcome data submitted by states to evaluate progress toward aims, using state-level percent change in outcomes, comparing 2011 baseline data to the most recently available data.

Results: All 13 states have reduced rates of early elective delivery since 2011. The average change was -25% (range: -39% to -4%) and 5 states have achieved the aim of -33%.  Nine states have reduced rates of smoking during pregnancy by more than the -3% aim (overall average change: -6%; range: -22% to 15%).  Two states have increased the percent of very low birth weight infants born in hospitals with Level III+ neonatal intensive care units toward the 20% aim (overall average change: 2.7%; range: -2.7% to 14.2%).  Outcome data for safe sleep and interconception care are pending.

Conclusions: Regions IV/VI states have made remarkable progress toward common goals in at least two of five priority areas to reduce infant mortality and improve birth outcomes, demonstrating early successes of this collaborative partnership.  Process measures are being examined to identify successful strategies that hold promise for replication.