Introduction: Infant mortality remains a significant problem in the United States driven by factors such as prematurity, congenital anomalies and sudden unexpected infant death. Well child visits (WCVs) offer an opportunity for pediatric providers to provide interconception screening, counseling and interventions for mothers to improve the outcome of subsequent pregnancies. Interconception screening, along with consistent screening for safe sleep practices, can have an impact on infant mortality rates at a low cost. We aim to screen and counsel (with interventions as necessary) 90% of mothers for maternal depression, birth spacing plans, folic acid use and tobacco use at WCVs for children less than 24 months of age by the end of a 9-month learning collaborative. In addition, we aim to screen/counsel 90% of families about safe sleep practices at WCVs for children less than 12 months of age. Methods: A learning collaborative was formed using the Institute for Healthcare Improvement Breakthrough Series model to implement the March of Dimes’ Interventions to Minimize Preterm and Low birthweight Infants using Continuous Improvement Techniques (IMPLICIT) Interconception Care toolkit for children less than 24 months of age. We added standardized safe sleep screening, counseling and intervention in WCVs through 12 months of age. Two pediatric clinics were recruited from a county with an infant mortality rate higher than the state average. An initial session brought both clinics together for quality improvement (QI) education and development of a process map for WCVs. A nurse in each clinic was designated the “infant mortality” champion to drive quality improvement work forward. The project leader and QI coach meet with the infant mortality champion in the clinic weekly to assist with planning plan-do-study-act cycles. Weekly data collection includes mothers with interconception screening performed and the number of families screened and counseled about safe sleep practices. A monthly webinar includes sites sharing data, successes, challenges and collaborating on changes. Participating physicians will be eligible for Maintenance of Certification Part IV credit at the end of the 9-month learning collaborative. Results: Baseline data varied between clinics with only one clinic performing some screening for safe sleep practices, maternal depression and tobacco use. To date, both clinics have successfully increased their safe sleep screening, counseling and interventions from baseline. (See Figure 1.) Both clinics are now working on tobacco screening and intervention and are on track to have all interconception screening implemented by October 2019. Final data will be available to be presented in run charts at the AAP NCE. Conclusion: Based on early results, we expect a quality improvement learning collaborative can be utilized to implement interconception care and safe sleep screening, counseling and interventions in a pediatric practice as a pathway to decreasing infant mortality in high risk areas.

Aggregated data from both pilot pediatric clinics