What is PPOR

Perinatal Periods of Risk (PPOR) is a comprehensive approach to help communities use data to reduce infant mortality. For a current video overview of infant mortality prevention, go to http://www.cdc.gov/about/grand-rounds/archives/2012/October 2012.htm.  Designed for use in US cities with high infant mortality rates, PPOR  brings  community stakeholders together to build consensus and partnership based on local data. It provides a framework and steps that help a community analyze their own local vital records data and then move from data to action. It can be used on its own or with existing infant mortality prevention efforts such as Fetal Infant Mortality Review (FIMR), Healthy Start, and home visiting. PPOR is about impact and results. It builds data capacity, promotes evidence-based decisions, strengthens partnerships, helps leverage resources, and enables systems change.

The initial analysis divides fetal and infant deaths into  four Perinatal Periods of Risk based on both birth weight and age at death.  The periods of risk are useful because causes of death tend to be similar within each, so when a community finds that its problems lie in only one or two periods of risk, efforts can be focused on those periods. A mortality rate is calculated for each period, to allow the stakeholders to compare populations within their jurisdictions, to examine time trends, and to compare to other cities, or to a reference group.

The PPOR reference group is a real population of mothers with near optimal birth outcomes. It provides a realistic benchmark or target toward which the community can strive. Assuming those outcomes are attainable, the reference group allows estimation of preventable or excess mortality for each period of risk. Periods of risk with the largest excess mortality become the community's focus for further study, to determine which of the known causes are likely to be most influential in that community. In this way, PPOR allows the stakeholders to prioritize their actions based on the best available evidence.

Urban communities across the U.S. have used PPOR as a way to monitor progress (surveillance), to guide public health planning, and to help prioritize prevention activities.

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