Transcript FROM DATA TO ACTION:

PROMISING PRACTICE:
The Integration of Medical, Social and
Educational Services in the Preconceptional
Period in a Philadelphia Health Care Center
M. Angert, DO, MPH; S. Mazzella, BSW;
A. James, MD, MPH; M. Silva, MS
Philadelphia PPOR Results,
1997-99
(95% C.I.)
Maternal
Health/
Prematurity
Maternal
Care
Newborn Care Infant Health
Lower North HS 10.7
(8.1-13.8)
3.8
(2.3-5.9)
2.7
(1.5-4.5)
3.6
(2.2-5.6)
All Phila.
5.6
(5.0-6.2)
2.9
(2.5-3.3)
1.4
(1.1-1.7)
2.3
(2.0-2.7)
2.1
(1.2-3.3)
.85
(.3-1.8)
.85
(.3-1.8)
.61
(.2- 1.4)
n=65,849
Reference*
n=8233
*Philadelphia Residents, White, non-Hispanic,
13+years of education, 20+ years of age
Calculating “Opportunity Gap”
Healthy
Start North
_
10.7
3.8
2.7
20.8
Reference
3.6
=
2.1
.85
-
Opportunity
Gap
.85
4.4
.61
8.6
2.3
=
1.9
15.8
3.0
PHASE II ANALYSIS
 Previous preterm delivery
 Chronic hypertension
 High parity
OBJECTIVES
 Engage the community in the process:
sharing data, teaching, listening
 Identify women of reproductive age with
risk factors and connect them with services
before they become pregnant
EXPECTED RESULTS
 Improve pregnancy outcomes
 Increase the number of health providers,
health educators and outreach workers who
understand the link between women’s health
and infant mortality
 Develop a formal system for referring high-
risk women to Healthy Start
 Raise community and patient awareness of
the relationship between preconceptional
health and birth outcomes
INTERVENTION
STRATEGIES
 Strategies will include the Healthy Start case
manager and require collaboration between family
planning and family medicine:
1. Women with a positive or negative pregnancy test will be
connected with Healthy Start at that visit.
2. Women seen in family planning who have medical risk
factors for preterm birth will be referred to Adult Medicine for
treatment and to Healthy Start for education and coordination
of interconceptional care.
INTERVENTION
STRATEGIES (cont.)
3. Women with history of preterm birth will be referred to
Healthy Start for education and, if needed, case
management services
4. Meet with primary care staff to discuss their role in
decreasing infant mortality through preconceptional care
RESULTS
 We are collecting information on the number of
referrals made to Healthy Start and to primary
care services
 Healthy Start will be conducting an evaluation
 We have compiled a list of community agencies
with which we have had discussions about healthy
babies
 R & E staff is now in place to help develop
evaluation plan
LESSONS LEARNED
 PPOR data is powerful, but is only the first step
 All partners must be at the table from the beginning:
the community, Healthy Start and the Health Center
 To keep the partners involved, meetings must occur
at regular intervals for exchange of information
WHAT WORKS
 Women in the family planning clinic, presenting
for a pregnancy test, were referred to Healthy
Start for educational and other services, whether
their pregnancy test was positive or negative.
 In this way, we were able to identify women
preconceptionally, look for risk factors, counsel
them, and direct them to services.
 Leaders in the medical community have been
interested in being part of the process.
WHAT DOESN’T WORK
 Women with risk factors seen in the family
planning clinic were referred to Adult Medicine,
but not to Healthy Start.
 More formal referral mechanisms had to be set
up. Consent forms were considered, but proved
too complicated because of HIPAA regulations
and inadequate staffing.
BARRIERS
 Difficulty in implementing systems change
in a bureaucratic structure
 Complicated consent and confidentiality issues
when two organizations (Health Center and
Healthy Start) collaborate
 Inadequate staff
 Inadequate funding
OVERCOMING BARRIERS
 Healthy Start has become a meaningful part of
the health care of women at the Health Center,
and has taken a lead in this process.
 While we have no additional funding, we have
identified a graduate student who will be involved
in the project. Her involvement will include
education, planning and evaluation.
PUBLIC HEALTH
IMPLICATIONS
 This program includes both “in-reach” and
outreach.
 If outreach is to be successful, it must be
expanded to include all medical providers,
schools, faith-based organizations, institutions of
higher learning, political organizations, public
health institutions, and social services providers
(nutrition, domestic violence, drug and alcohol
services).