Transcript Infant Mortality Rates in the District of Columbia

National Capital Strong Start
Health Services For Children with
Special Needs, Inc.
(HSCSN) OB/GYN Provider Forum
Gabriela Garcia
Director, Center for Perinatal
Advocacy at Providence
September 24, 2013
Project Aim: By 2016 the National Capital Strong Start program will
improve birth outcomes by achieving a 20% decrease in pre-term birth
and low birth weight infants as compared to the DC 2012 rates.
Objectives
By the end of this presentation, the listener will be able
to:
 Identify models of enhanced prenatal care aimed at
prematurity
 Identify local implementation of these models in the
District
How did we get here?
Significant Disparities
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Wards 5, 6, 7 and 8, where 77% of residents are
African American and rates of pre-term birth and low
birth weight exceed the national average.
The percentage of the population enrolled in
Medicaid is higher in DC than in any other state, with
28% of DC residents and 61% of District children
relying on the Medicaid program.
In 2009, low birth weight infants accounted for
10.3%, of births in the District
The District’s 2009 preterm birth rate was 14.2%
Historic Partnership of 13 organizations
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Howard University Hospital
Medstar Georgetown University Hospital
Medstar Washington Hospital Center
Providence Hospital
Community of Hope’s Family Health and Birth Center
Mary’s Center
Unity Health Care
Chartered Health Plan
Health Services for Children with Special Needs, Inc.
United Healthcare Community Plan
DC Department of Health’s Center for Policy, Planning, and Evaluation
DC Department of Health Care Finance, and
Healthy Babies Project
Enhanced Prenatal Care
CenteringPregnancy®
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Enhanced Prenatal Care through
Centering/Group Visits – group prenatal
care that incorporates peer-to-peer
interaction in a facilitated setting for health
assessment, education and psycho-social
support
provided at Providence Hospital’s Center for
Life and Washington Hospital Center
Enhanced Prenatal Care at
Birth Center
• Enhanced Prenatal Care at Birth Center –
comprehensive prenatal care facilitated by
teams of health professionals including peer
counselors. Services include collaborative
practice, intensive case management,
counseling and psycho-social
• Support to be provided at Community of
Hope’s Family Health and Birth Center
Enhanced Maternity Care
at Maternity Care Homes
• Enhanced Prenatal Care at Maternity Care
Homes – enhanced prenatal care including
psychosocial support, education and health
promotion in addition to traditional prenatal
care. Services provided will expand access to
care, improve care coordination and provide a
broader array of health services
• Provided at Howard University Hospital and
Unity Health Care, Mary’s Center
Overview of NCSS Program
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CMS Innovations Center awarded $1.8 million to Providence
Hospital Foundation
The NCSS project will serve 3,705 Medicaid pregnant women
and their infants over three years.
The National Capital Strong Start Program’s Operation
definition for high-risk preterm birth is Medicaid eligibility + at
least 1 IOM risk factor(s).
Each provider will make the initial assessment and a CMS
intake form (a 3rd trimester, 6-week postpartum form, and exit
form are still forthcoming)
Risk factors and utilization are defined by model
Medicaid Birth Served by Model
Figure C. Medicaid Births Served by Model
Year One
Year Two
Year Three
Total
Providence Hospital
100
100
100
300
Washington Hospital Center
80
100
130
310
105
155
160
420
Howard University Hospital
277
300
253
830
Mary’s Center
200
225
250
675
Unity Health Care
170
500
500
1,170
932
1,380
1,393
3,705
CenteringPregnancy®
Birth Center
Community of Hope FHBC
Maternity Care Home
Total
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Grant Application: Providence, Providence Health Foundation Grant Convener: Providence, The Center for Perinatal Advocacy at Providence
(Total Expected Patients Served 3705: Yr 1=932, Yr 2=1380, Yr 3=1393)
Maternity Care Home
(Yr 1: 647, Yr 2: 1025, Yr 3: 1003)
Birth Centers
(Yr 1: 105, Yr 2: 155, Yr 3: 160)
Howard
University
Hospital
Mary’s Center†
Unity Health
Care†
Community of Hope
(277/300/253)
(200/225/250)
(170/500/500)
(105/155/160)
CenteringPregnancy®
(Yr 1: 180, Yr2: 200, Yr3: 230)
Medstar
Washington
Hospital
Center
(80/100/130)
Providence
Center for Life
(100/100/100)
Medstar Georgetown
University Hospital
Chartered
Health Plan
Health
Services for
Children
with
Special
Needs, Inc
United
Healthcare
Community
Plan
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Data Indicators (5)
1) gestational age at delivery
2) birth weight
*3) entry into prenatal care/number of visits
*4) maternal/fetal complications and c-section
*5) history of pre-term birth
Grant Manager
DC Department of Health,
Center for Policy, Planning,
and Evaluation
DC Department of
Health Care Finance
CMS
CONTRACTOR
Services at CenteringPregnancy®
Sites
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CenteringPregnancy® model, as approved by the Centering Institute is a multifaceted
model of group care that integrates the three major components of care: health
assessment, education, and support.
Groups of 8-12 women with similar gestational ages meet together, learning care
skills, participating in a facilitated discussion, and developing a support network with
other group members.
8 to 10 sessions that are 90 to 120 minutes in length. Jointly facilitated by a certified
Nurse-Midwife and another trained professional, usually a social worker.
Each session begins with a private medical assessment completed in a separate part
of the room where the mother shares problems and concerns with a health
professional and the health status of the baby is evaluated.
Women participate actively by taking their own blood pressure and weight and
recording these indicators in their charts.
The medical assessment is followed by a facilitated group educational presentation
where women receive information and instruction on a variety of subjects. Curriculum
includes: nutrition/exercise, pregnancy discomforts and interventions, family role
models, sexuality, childbirth preparation, transition to parenthood, breastfeeding and
baby care.
Services at Birth Center
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NCSS will enable certified Nurse Midwives through a patient navigator at
FHBC to provide prenatal care to 420 Medicaid women over three years.
Women begin their participation with an orientation to FHBC, which
includes a first visit with a midwife to ensure that patients are fully
educated on the model and are medically appropriate for a birth center.
For the first two trimesters of pregnancy, women will have monthly
individual visits with a midwife, with support from the patient navigator.
COH will enhance their volunteer doula program and hire a patient
navigator to support women through their pregnancy. The navigator will
also assist with the social needs that high risk women face at FHBC which
may lead to pre-term deliveries or low birthweight babies.
The Patient Navigator will work with the midwives, medical assistant, and
breastfeeding peer counselors, to ensure that mothers are making
appointments, getting needed referrals, and getting the social services
support they may need.
Services Maternal Home Model: 9
Sites
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Model based on National Center on Quality Assurance (NCQA) Patient
Centered Medical Home (PCMH) model of care for primary care and
Geisinger Health Systems ProvenCare Perinatal model.
Screen for behavioral risk factors associated with pre-term birth, including
nutritional status and history of smoking, alcohol and substance abuse;
Coordinated care from an interdisciplinary team of on-site staff, including
medical, nursing, and health promotion professionals;
Access to Maternity Care Home (MCH) Navigators, who will help to
engage and educate participants, providing structured brief interventions
focused on the importance of eliminating alcohol and substance abuse
and linking them to smoking cessation, nutrition and other social services;
Culturally and linguistically appropriate support including translation
services; and
Access to a 24/7 clinician support line.
Next Steps toward implementation
Institutional Review
Board, Final details
 Subcontracting to
partner sites (5)
 Data and Reporting to
CMS
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References
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Henry J. Kaiser Family Foundation State Health Facts. Available at:
http://www.statehealthfacts.org.
Working together for Health, Medicaid Annual Report FY2008, DC Department
of Health Care Finance. Pg 4 and 10. Available at: http://dhcf.dc.gov/dhcf.
Henry J. Kaiser Family Foundation. State Health Facts, DC: Preterm Birth as a
Percentage of all births, 2009. Available at: http://www.statehealthfacts.org.
Henry J. Kaiser Family Foundation. State Health Facts, DC: Birth of Low
Birthweight as a Percent of All Births by Race/Ethnicity, 2009. Available at:
http://www.statehealthfacts.org.
Centering Healthcare Institute, Centering Pregnancy Overview, available at:
www.centeringhealthcare.org/pages/centering-model/pregnancy-overview.php
Chasnoff, I; McGourty, R., Pre-Treatment: A Brief Intervention for the Primary
Care Setting. National Training Institute, 2003.
Thank you! Questions?
Gabriela A. Garcia
Director, Center for Perinatal Advocacy at Providence
[email protected]
202-552-4878