1. birth who are born in facilities designated as Level II or III perinatal care centers.

    Given current limitations in our understanding of how to prevent preterm (and therefore low-weight) births, it is important that high-risk births take place in facilities that can care for both the mother and the infant. Health care providers and hospitals play a primary role in directing women to appropriate facilities. With the development of a HEDIS 3.0 measure for Medicaid enrollees, health plans are likely to develop the capacity to provide this information. Other sources of data might be hospital discharge data systems.

  2. Percentage of 1-year-olds who have received all age-appropriate immunizations recommended by the Advisory Committee on Immunization Practices.

    The value of immunizations is clear, but currently few communities have a system to track immunizations or produce information that can help ensure that children are immunized on time. Recent data collection efforts have focused on the immunization status of 2-year-olds. Similar approaches might be used to obtain information on 1-year-olds. Because children can be immunized in many different places, it can be difficult to aggregate the information across a community to be sure every child is up to date. Some communities are developing immunization registries, which should make it possible to assess immunization status for any age group. Techniques being developed by health plans to produce HEDIS data for 2-year-olds could be adapted for 1-year-olds. Once systems are functioning, inadequately immunized children can be identified more easily and consistently, and responsibility for their immunization can be established and followed. Achieving improved immunization rates will require concerted cooperation across many segments of the community.

The indicators selected to provide an overall tool for assessing efforts in a community to improve infant health are a small segment of what might be a very large collection. These indicators bring together measures of health risk (birth weight, environmental tobacco smoke, and immunization) and actions in the community that can help reduce health risks (assistance programs, school enrollment, paid leave, insurance coverage, and referral for delivery). These indicators address infant health both directly and through the health of mothers.

They also address how various community stakeholders are



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