Dr. William Sappenfield, director of the USF Chiles Center and a professor in community and family health at the University of South Florida College of Public Health (COPH), is a co-author of the peer-reviewed study “The Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality: An Outcome Evaluation From the US South, 2011 to 2014.” The study was published recently in the American Journal of Public Health.
CoIIN is a federally supported initiative that brings together experts and practitioners (data experts, Medicaid officials, health officers, epidemiologists, etc.) to collaborate on best practices and institute changes to lower infant mortality.
“It’s group learning to promote public health,” noted Dr. Sappenfield. “Because of the collaborative nature of the initiative, we were able to get rapid feedback on the progress we were making and where. It gave us the opportunity, on a repeated basis, to discuss progress, challenges and potential solutions that allowed us to take best practices to the field more readily.”
Dr. Sappenfield and his co-authors specifically focused on CoINN initiatives in Southern and Southwestern states. The CoIIN teams identified five “shared priority areas” for lowering infant mortality. Those five areas were: reducing early elective deliveries (before 39 weeks); expanding access to interconception care for high-risk women; promoting safe infant sleep practices; reducing smoking in pregnancy; and improving regionalized systems of risk-appropriate perinatal care.
The teams operated under a “plan—do—study—act” strategy. Thanks to the cooperative focus of the teams, “we didn’t have to wait long to see the progress states were making and then figure out what to do next,” Dr. Sappenfield explained. “That contributed to rapid change.”
While infant mortality did not go down significantly in the CoIIN states studied, other positive gains were made. This includes a 22 percent reduction in early elective delivery (versus 14 percent in non-CoIIN states), a 7 percent increase in smoking cessation while pregnant (versus 2 percent in other states) and a 4 percent decrease in preterm birth, twice what was observed in other regions.
The results were impressive, but not necessarily surprising, said Dr. Sappenfield. “Evidence in the literature shows that when you work collaboratively, you can put out greater effort, quicker effort and more sustained effort — and therefore have greater results.”