Transcript Reducing Low Birth Weight Babies and Saving Infants

Improving Interconception Care for
High Risk Women
February 10, 2011
Low Country Healthy Start
“Every Woman Southeast Initiative” Webinar
Virginia Berry White, LMSW
[email protected]
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Interconception Care – Learning Community
– MCHB, HRSA, Healthy Start Program
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Improve Health and Well-Being of Women
Advance Quality & Effectiveness of Interconception Care
Implementation of Evidenced-Based Practices
Innovative Community-Driven Interventions
Home Team and Traveling Team (Learning Sessions)
Expert Work Group
Abt Associates, Inc. and Johnson Group Consulting, Inc.
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Interconception Care – Learning Community
– MCHB, HRSA, Healthy Start Program
• All Healthy Start Programs are required to participate
• CQI Process, using Plan, Do, Study, Act principles
• Choices of Major Focus Area include:
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Family Planning & Reproductive Health
Primary Care Services & Linkages
Maternal Depression & Mental Health
Healthy Weight
Risk Screening
• Low Country Healthy Start (LCHS) chose Family
Planning and Reproductive Health – strongly linked
with working with primary care providers
Route to Get to:
1. Strengthening partnerships and linkages among providers
2. Taking evidenced-based protocols and implementing
3. Improving staff training and protocols to improve quality and consistency
HS ICC-LC
About LCHS
• Part of the SC Office of Rural Health
• Service area is four rural counties in the Low Country
region of the state
▫ Allendale, Bamberg, Hampton and Orangeburg
• Six (6) sites
• LCHS is staffed by masters prepared social workers and
lay home visitors, called Client Navigators
• Home Visiting, Case Management, social work, outreach
and coordination program
• Target population is African American women
Description of Project Area
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Very poor, under-resourced counties
Birthing Hospital in only one of four counties
High unemployment rates
In 2008, there were 1,385 African American live births
in the service area, 592 white births and 23 other
In 2010, LCHS provided services to 1, 449 families 380 pregnant women, 409 postpartum women and 660
infants
LCHS program criteria, woman at risk for poor
pregnancy outcomes and her newborn
Reduce the rate of Infant Mortality
Eliminate disparities in perinatal health
Infant
Mortality:
2005- 2008
Service Area
IMR
Data
County, Service
Area, State
White
Black & Other
Total
Number
Rate
Number
Rate
Number
Rate
Allendale
2
19.8
10
21.3
12
20.8
Bamberg
1
4.5
3
5.4
4
5.1
Hampton
1
2.2
9
12.3
10
8.4
Orangeburg
20
12.1
71
18.6
92
16.6
Service Area
24
9.9
93
16.7
118
14.6
South Carolina
983
6.2
1,101
13.3
2,111
8.6
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Barriers (
serving High Risk Women
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• Lack of insurance coverage
• Women not knowing services that are available, i.e.,
Family Planning Waiver
• Access to care
• Woman’s access to contraceptives of her choice
• Psychosocial and economic issues
• Client retention during the interconception
(postpartum) period
• Coordination of care
• Shortage of providers
Barriers (
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serving High Risk Women
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Patient-Provider Communication/Relationship
Time allotted to counsel women during office visits
Inability for providers to pay for long-term methods
Few obstetric and prenatal providers
Women understanding of what is required to increase
her chances of having a healthy baby
• Women inability to secure access to risk appropriate
care
• Health of Women of Childbearing Age
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LCHS Interconception Care, Family
Planning & Reproductive Health
• Increase the percent of intended pregnancies
▫Address Barriers
▫Partnership with Provider and LCHS program
participants
• Decrease unintended pregnancy
▫Family Planning Options/Link to FP Services
▫Pregnancy Spacing
▫Survey Family Planning Providers
• Decrease late prenatal care
• Decrease poor pregnancy outcomes when women do not
intend to be pregnant
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Model: Use of Multidisciplinary Teams (MDT) for
Addressing Interconception Care for High Risk Women
• Partners
▫ Private obstetric practices
• Monthly Meetings
• Forge closer connection between LCHS and the perinatal
providers
• Specific client centered discussions aid in learning and
teaching, as well as joint care planning
• MDT learn from LCHS more about the client’s home
situation and home/life stress
• LCHS staff learn more about the clinical side of prenatal,
postpartum and interconception care
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Successes/LCHS and Providers
“Voice of the Providers”
• Certified Nurse Midwives involving Obstetricians
• Tie LCHS work, Interconceptional Focus into
Prematurity Prevention (begins before next pregnancy)
• Insight gained into the needs of women
• Centering Pregnancy – prenatal & postpartum periods
• Home visits are key, esp. to high risk women with
subsequent pregnancies
• Find ways to provide family planning services to indigent
clients
• Standing order through birthing hospital (women will
leave the hospital with a method)
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Data System
• Client’s Reproductive & Interconception Health begin at
prenatal
▫ Risk Assessment
• Automated trigger reminders – LCHS Data System
▫ Reminder about EDC & delivery date, Family Planning option,
Postpartum exam
• Automated edit reports – LCHS Data System Specific information missing from client’s file - Examples:
▫ Did she leave hospital after delivery with a method?
▫ What is the postpartum visit date? Did she go?
▫ Birth control method selected? Did she receive?
▫ Tracking client by method selected and follow-up dates by type
of method.
Implementing Changes - Steps
LCHS staff were trained on the importance of women
understanding birth control methods, trained on the
effectiveness and risks of each and trained to discuss
methods with women, helping them choose
LCHS staff were trained on program expectations of when
in the prenatal period BC methods will be discussed, how
to document, the expectations for close follow-up and
documentation in the two years after delivery
Data collection tools and logs were discussed, along with
responsibility for completion
Data are collected, results analyzed and shared with the
PPAG and Home Team.
Success to Date
• LCHS developed a tracking log used by staff to collect
and report data on each client after she delivers.
• Improvements have been documented in the number of
women leaving the birthing hospital in the service area
with Depo Provera (or a permanent method such as tubal
ligation or hysterectomy).
• Results and progress are reported to partners, the
Perinatal Provider Advisory Group, MDT members and
LCHS Staff.
• The PPAG and MDT partners are consulted about the
strategy, implementation success and are frequently
asked for additional input.
Success to Date
• Providers are now openly discussing what has to be done
to help women gain access to effective long-lasting
contraceptives, particularly the Mirena IUD.
• LCHS has met with the SC Primary Care Association,
who then agreed to form a study group, to determine
how the FQHCs can overcome perceived barriers to
providing long acting, effective birth control methods for
clients.
• LCHS has met with physicians and NP representing all
FQHCs in the service area to identify problems and find
solutions.
Measuring Change
 # of partners (delivering providers) using the protocol to assure women are
discharged from the hospital, after delivery, with a method. LCHS will
partner with 4; 1 per county.
# of primary care partners accepting our referrals and assisting
clients to select and use an effective contraceptive method.
Planned number is 8; 2 per county.
Assisting clients with selecting and using an effective contraceptive
method is defined as LCHS or the client securing an appointment
within 2 weeks of appointment request. Payment for care is not a
barrier which means the client has Medicaid, other insurance
and/or the provider has agreed to accept LCHS referrals for free,
or low cost or uses a sliding fee scale .
 # of LCHS post-partum clients using a birth control method effectively at 3,
6, 9, 12, 18, 24 months. Target is 75%.
Where do we plan to go from here?
1. Improve data collection and data quality. Make data collection more seamless,
clarify what is needed and why. Make data fit with data staff already report.
2. Continue to work with the FQHCs and assure they work with women, prescribe
the method women want and then provide the method.
3. Work with Title V to determine what can be done to improve access to Title X
required services given the county health department staffing issues. Propose
Title X sub-contract to other providers for services they cannot provide
adequately, appropriately or timely.
4. Continue to work with the birthing hospital and obstetric providers to keep the
focus on interconception care.
5. Work with other hospitals, outside the service area, to use the protocol.
6. Continue to find (and implement) even more effective ways to help women
advocate for their own reproductive health desires, requirements and needs.
Low Country Healthy Start
Post Office Box 2889
Orangeburg, SC 29116
803-531-8008
803-531-8007 – Fax
Virginia Berry White, LMSW
[email protected]