More Utah Women Giving Birth Out of Hospitals

(Salt Lake City, UT) – At the dawn of the 20th century, nearly all Utah babies were born at home. By 1969, only one percent were, as hospitals became the go-to place for moms to deliver. Fast-forward to 2014 and the trend is changing again, with nearly 3,700 babies, or 10 per day, delivered either at home or in a freestanding birth center according to statewide birth certificate data. 

The Maternal and Child Health Bureau at the Utah Department of Health (UDOH) partnered with Utah physicians and midwives to issue a new report to examine these trends, identify opportunities to improve data collection, and address potential areas for improving outcomes.  Using vital records data, the report reviewed out of hospital (OOH) births that occurred in Utah between 2010-2012. The report is available by clicking here.

“As more Utah women are choosing out of hospital births, it is critical that we identify and address issues that impact maternal and neonatal safety, including provider qualifications, provider-to-provider communication, and timely hospital transfer,” said Erin Clark, Maternal Fetal Medicine Physician at the University of Utah Health Sciences Center and one of the report’s authors. 

Between 2010 and 2012 a total of 139,958 full-term babies were born in Utah. Most of those births (136,625) occurred in hospitals under the care of a physician or certified nurse midwife. The remaining 3,693 births occurred as planned OOH births. The report examined the trends and characteristics of these births and found:

• Utah’s OOH birth rate doubled between 1990 and 2012

• 2,595 births occurred at home, while 1,098 occurred in birthing centers

• More than two-thirds of the births were attended by unlicensed midwives

• Other births were attended by Licensed Direct-entry Midwives, unlicensed midwives, Certified Nurse Midwives, and naturopathic physicians

The report also compared women who deliver in hospitals to women who choose OOH births and found women choosing OOH births:

• Tended to be older, white and non-Hispanic, married, and of rural residence

• Were at a healthier weight prior to pregnancy, had five or more prior births, and were more likely to have paid for their deliveries out of pocket

• Were more likely to have no prenatal care (home birth 1.9% vs. hospital 0.3%) or inadequate prenatal care (home birth 39.1%, birth center 30.5%, vs. hospital 14.9%)

• Were less likely to begin care in the first trimester (home birth 52.9%, birth center 48.5%, vs. hospital 75.3%)

• Had fewer overall complications, with the exception of higher rates of premature rupture of membranes (more than 12 hours), precipitous labor (less than 3 hours) and prolonged labor (more than 20 hours)

Additionally, the neonatal death rate among Utah babies delivered at home was found to be more than double that of babies born in hospitals, which mirrors findings from a recent national analysis. 

“Unfortunately, we are limited in our ability to further analyze data by birth attendant or to rigorously assess outcomes in this analysis by the relatively small numbers in the out of hospital birth cohort during the study period,” said Lois Bloebaum, director of Maternal and Child Health Quality Improvement at the UDOH and one of the report’s authors.

Bloebaum went on to say, “While the neonatal mortality rate among home births was significantly higher (95% C.I. p=.05), future analysis will indicate whether this finding is of concern or an artifact of small numbers.  We were also unable to calculate the neonatal mortality rate among birth center births at this time due to small numbers.”

Several recommendations have been identified based on this analysis, some of which include more precise collection of data on this topic. Changes to the Utah Birth Certificate have already been made and changes to the Utah Fetal Death Certificate are in process to enable more precise data collection. The Maternal and Child Health Bureau is also working collaboratively with Utah midwives and physician partners to improve communication and reporting among in-hospital and out of hospital providers when a transfer to a hospital becomes needed.

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Media Contact:

Lois Bloebaum

Utah Department of Health

Bureau of Maternal and Child Health

801-557-0035

 

The mission of the Utah Department of Health is to protect the public's health through

preventing avoidable illness, injury, disability and premature death, assuring access to

affordable, quality health care, and promoting healthy lifestyles.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number 1 B04MC28130¬01¬00, Maternal and Child Health Services ($5,777,200.00 FROM: 10/01/2014   THROUGH: 09/30/2016) 0.00% was financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government

New Program to Deal with Prehospital Complaints

(Salt Lake City, UT) – Striving for consistent high quality care in the prehospital experience for anyone who requires emergency medical care in Utah, the Bureau of Emergency Medical Services and Preparedness (BEMSP), Utah Department of Health (UDOH), is pleased to announce the creation of the Complaint, Compliance and Enforcement Unit (CCEU). According to Dennis Bang, Director of the newly created unit, “We will investigate complaints and compliance concerns related to any entity or person who provides emergency medical services in a prehospital setting in the state.” Bang says it will allow the general public and even other state agencies to file complaints against anyone who is licensed or certified by the bureau.

Investigators with the CCEU will also be tasked with investigating compliance issues that are received by other areas of the bureau.  Concerns could range from issues involving improper equipment to licensing or certification concerns about people or EMS providers.

In addition, officials are unveiling a new disciplinary protocol to be used in conjunction with complaint and compliance issues. This creates uniformity for state actions against those who fail to follow the bureau rules and Utah state law.  It’s hoped this will encourage compliance within the profession, increase public trust, and ultimately improve patient care.

The Bureau of Emergency Medical Services and Preparedness is dedicated to the well-being of Utah citizens and the visiting public. Bang adds, “It is our hope that this process will increase EMS performance statewide and reassure the public that we have a dedicated system that can be used to address concerns related to their care.”

You may file a complaint by visiting the bureau’s website at https://health.utah.gov/ems/ or by calling (801) 273-6629 to request a complaint form.

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Media Contact:

Charla Haley

(o) 801-273-4178

(m) 801-230-5927

Utah Named 5th Healthiest State in the Nation

(SALT LAKE CITY) —Utah continued its steady climb toward becoming the healthiest state in the nation with the release of the annual United Health Foundation’s America’s Health Rankings™ report. The report named Utah the 5th healthiest state in the nation, improving on its rank of 6th in 2013 and 7th in 2012.

The report highlighted several strengths that lead to Utah’s ranking, including the lowest rates in the nation for tobacco use (10.3%) and cancer deaths (145.7 deaths per 100,000 residents), and the second-lowest rate in the nation of adult diabetes (7.1%).

“One of our strategic goals is to become the healthiest state in the nation, and I’m pleased that we are continuing to work in that direction,” said David Patton, executive director of the Utah Department of Health. “Utah should be proud of this ranking, it’s evidence that our strong public health and health care systems are doing right by the people of our state.”

Utah was ranked as one of the top five states for several key health indicators, including:

• The lowest adult smoking rate in the U.S. at 10.3%;

• The lowest prevalence of adult diabetes at 7.1%;

• The lowest rate of children living in poverty at 9.2%;

• The 2nd lowest rate of preventable hospitalizations;

• The 4th lowest rate of obese adults at 24.1%;

• The 4th lowest rates of binge drinking, Chlamydia cases, and Salmonella cases; and

• The 5th lowest rate of adults reporting “poor physical health” days in the past month.

The report also highlighted several challenges Utah must overcome to achieve its goal of becoming the healthiest state.

“Unfortunately, even in our strengths we find challenges,” Patton said. “Compared to other states our obesity and physical inactivity rates are low, but both rates are trending upward. Obesity can lead to several chronic, deadly diseases; it’s entirely preventable and remains one of the top public health challenges of our time.” 

Other challenges the report highlighted were Utah’s high rate of prescription drug deaths, low immunization rates among teens, and the limited availability of primary care providers.

The state’s lowest rankings were:

• 46th for prescription drug overdose deaths;

• 45th for cases of Pertussis, or whooping cough;

• 44th for teen immunization rates;

• 44th for the number of primary care physicians;

• 39th for air pollution.

The entire report is available online at www.americashealthrankings.org.

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Tom Hudachko | Public Information Officer

Utah Department of Health

(o) 801-538-6232

(m) 801-560-4649

Utah Adolescent Health Varies by Local Health District

(Salt Lake City, UT) – For the first time ever, new, self-reported data show which areas of the state have the healthiest teens. “This is the first time we’ve been able to look at adolescent health by geography,” said Michael Friedrichs, UDOH Epidemiologist. “It’s exciting and incredibly important because school administrators, local health leaders and parents can now better identify the health and safety needs of this population.”  

Report findings have uncovered health problems that vary widely across the state and also within local health districts. For example, in the Weber-Morgan Health District, no indicators ranked better than the state rate. In fact, 11 of the 29 indicators were worse than the state, including: screen time, obesity, family meals, cigarette smoking,  e-cigarette use, exposure to smoking at home, secondhand smoke exposure, current asthma, diabetes, driver texting, and feeling sad or hopeless.

In contrast, in Utah County Health District, only three (asthma management, driver talking on a cell phone, and driver texting) of the 29 indicators were ranked worse than the state, showing that even in relatively healthy communities, health and safety concerns still exist.

The 2013 Utah Adolescent Health Report uses data from the Prevention Needs Assessment (PNA) survey. The PNA surveyed a random sample   of students in grades 8, 10, and 12 in the spring of 2013 on substance abuse, tobacco use, asthma, diabetes, healthy weight, physical activity, nutrition, tanning, violence, and injury. Response was voluntary and parents approve their student/s’ participation.

Other highlights of the report include:
    • Salt Lake County and Tooele County Health Districts had significantly higher rates of psychological distress, making a suicide plan, and attempting suicide compared to the state.
    • One in four Utah students reported having been threatened or harassed over the Internet, by email, or by someone using a cell phone, with the highest prevalence seen in Salt Lake County Health District at 26.8%.
    • At 5.8%, the prevalence of current use of e-cigarettes is higher among Utah students than current cigarette smoking (3.9%). In Weber-Morgan Health District, 20% of the students reported current e-cigarette use.
    • Adolescents in Utah County (65.0%), Wasatch (65.2%), and Weber-Morgan (65.4%) Local Health Districts reported significantly higher rates of riding in a car with a driver who was texting compared to the state (61.3%).
    • Central, Southeastern, Southwest, Tooele County, and TriCounty adolescents reported significantly lower seat belt use compared to the state.

“Opportunities for change exist all around us, from using permanent signs as an easy way to inform parents and visitors that school property is a tobacco-free zone, to ensuring an asthma action plan is completed yearly by parents of children who have asthma,” said Heather Borski, Director, Bureau of Health Promotion, UDOH.
The data are presented in tables, graphs, and maps to help show the percentage of Utah students in grades 8, 10, and 12 who are affected by different health issues and where problems are concentrated in the state.

Topics in the report include:
    • Lifestyles (computer screen time, physical activity, youth obesity, family meals, tanning, tobacco use)
    • Chronic conditions (asthma, diabetes)
    • Violence and injuries (motor vehicle safety, prescription drug abuse, bullying)
    • Mental health (feeling sad or hopeless, psychological distress, suicide)

For a full copy of the 2013 Adolescent Health Report, visit http://www.choosehealth.utah.gov/prek-12/schools/data.php.

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Media Contact
Michael Friedrichs
UDOH Epidemiologist
801-538-6244

New Tools Launched to Improve Health Services for Diverse Communities

(Salt Lake City, UT) – Utah’s increasingly diverse population poses unique challenges to health care facilities and public health agencies that serve growing numbers of clients and patients. In response to a growing number of requests for assistance, the Utah Department of Health Office of Health Disparities (OHD) has developed a training video and a practical toolkit to help state and local health agencies put into practice a set of national standards for Culturally and Linguistically Appropriate Services (CLAS).

To ensure the materials are relevant, the CLAS video and toolkit are based on nationally promoted best practices, as well as Utah-specific information obtained through surveys and interviews with personnel from 36 programs from state and local health departments. The results revealed a significant need for CLAS standards and policies, as only 15% of the surveyed personnel felt their programs were “fully capable” of providing verbal or written language assistance to people with limited-English proficiency (LEP).

Language assistance is only one component covered under CLAS standards, and all health care organizations can benefit from enhancing their culturally- and linguistically-appropriate approaches to staff training, governance, workforce diversity, and policy making.

The CLAS video, “A Class about CLAS”, provides an overview of CLAS themes and features expert commentary and guidance from public health agencies, health care organizations and community-based organizations.

To provide practical guidance for anyone interested in implementing CLAS standards, the CLAS Toolkit offers discussion scenarios and highlights real examples of CLAS-related practices and policies now used across Utah. “We believe all health care organizations and public health agencies can benefit from these tools,” said UDOH Office of Health Disparities Outreach Coordinator Jake Fitisemanu, who notes that CLAS standards compliance is mandated for all programs that receive federal funds and all agencies seeking national accreditation.

The CLAS video and toolkit, along with additional CLAS-related resources, are available online for free download at www.health.utah.gov/disparities/training/CLAS.html.

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Media Contact
Jake Fitisemanu
Outreach Coordinator
Office of Health Disparities
385-315-0220