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C M Britton

Publications and source records attributed to C M Britton.

2 recordsLinked to original sources
PubMed1998

The application of a risk-approach model to reduce mortality in infancy.

OBJECTIVES: To examine the utility of a risk-approach model in identifying infants at greater risk of postneonatal mortality (PNM) and to determine whether there is a relationship between PNM and linkage of at-risk infants to primary health care. METHODS: The Sheffield Birth Score instrument was applied to 90,846 newborn infants to determine high-score (HS) and low-score (LS) infant risk groups. Health care visit data were collected on all HS infants who were referred for primary pediatric care. Mortality rates were calculated for both HS and LS infant groups and for HS infants who were linked and not linked to care. RESULTS: The HS infant group was at significantly greater risk of PNM (p < 0.0001). The linked group had a lower PNM rate (p < 0.05), and linked/not-linked group differences were noted for 11 of 20 variables. When these 11 variables and the linked/not-linked variable were entered into a logistic regression analysis, linkage was the only significant variable (p < 0.01) in predicting PNM. CONCLUSIONS: The Sheffield Birth Score differentiated at birth those infants who were at greater risk of PNM. The lower incidence of PNM among linked HS infants suggests a promising argument for early pediatric intervention. Further research to clarify specific factors that influence health care participation decisions is suggested.

Humans↗
PubMed1995

Reducing postneonatal mortality in West Virginia: a statewide intervention program targeting risk identified at and after birth.

OBJECTIVES: Excessive postneonatal mortality in West Virginia has been associated with inadequate health care. This paper describes two interventions aimed at those infants at greatest risk of dying. METHODS: Two systems of risk-related intervention were simultaneously introduced and funded statewide from 1985 through 1987. Risk status was determined by a multifactorial score at birth or clinical risk factors later. At-risk infants were linked with physicians who provided specified care plans. All infants were followed for 1 year for mortality. RESULTS: Of 4570 infants with a high Sheffield Birth Score, 45%, together with 1003 infants with clinical risk factors, received specified care plans. High-risk infants constituted 7.6% of total resident births. Odds ratios for overall postneonatal mortality and sudden infant death syndrome in high-birth-score infants compared with low-birth-score infants were 6.2 (95% confidence interval [CI] = 4.2, 9.3) and 11.2 (95% CI = 5.4, 23.2), respectively. The relative risks of postneonatal mortality were similarly significant for infants with most clinical risk factors. During the program there was a 21.4% reduction in the trend of yearly standardized mortality ratios, which differed markedly from the trend in surrounding states. The data suggest that 33 lives were saved at a cost of $36,363 per infant. CONCLUSION: Ensuring affordable, available, accessible, and acceptable care for a small group of at-risk infants was associated with a dramatic drop in overall postneonatal mortality in West Virginia.

Adult↗