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Dougherty County CenteringPregnancy ®

Dougherty County CenteringPregnancy ®. A public-private collaboration to improve access to prenatal care and perinatal outcomes For Low-Income Women. Jacqueline H. Grant, MD, MPH, MPA Southwest Health District Director. Objectives.

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Dougherty County CenteringPregnancy ®

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  1. Dougherty County CenteringPregnancy® A public-private collaboration to improve access to prenatal care and perinatal outcomes For Low-Income Women Jacqueline H. Grant, MD, MPH, MPA Southwest Health District Director

  2. Objectives • Describe the barriers to early entry into prenatal care for South Georgia low-income women • Review baseline birth outcomes data • Provide an overview of the CenteringPregnancy® model and steps towards implementation • Describe the public-private collaboration • Demonstrate its effectiveness

  3. Barriers to Early Prenatal Care Access Presumptive Eligibility Medicaid Documents needed for Medicaid birth certificate picture identification card (16 and older) proof of address proof of family income proof of pregnancy Schedule and keep NOB appointment

  4. Historical Perinatal Data baseline OUTCOMES

  5. Infant Mortality Rankings (Ascending) 1960-2002; Selected Countries (Health United States 2005)

  6. Infant Mortality Rates 2004-2008 IMR= no. of infant deaths <1 yr/live births x1000 African-Americans Georgia: 13.1 SWHD: 11.8 Baker: * Calhoun: * Dougherty: 12.6 Lee: 14.9 Mitchell: 9.4 Terrell: 15.4 Worth: 9.9 Caucasians Georgia: 6.1 SWHD: 7.6 Baker: 0 Calhoun: 0 Dougherty: 11.3 Lee: 6.3 Mitchell: 7.2 Terrell: * Worth: 11.1

  7. % Low Birth Weight*: 2004-2008 *LBW %= % of births <2500 grams African-Americans Georgia: 14.1 SWHD: 15.6 Baker: 16.7 Calhoun: 13.6 Dougherty: 15.3 Lee: 14.3 Mitchell: 15.2 Terrell: 20.0 Worth: 15.1 Caucasians Georgia: 7.1 SWHD: 8.0 Baker: * Calhoun: 7.5 Dougherty: 9.0 Lee: 6.6 Mitchell: 8.2 Terrell: 10.1 Worth: 9.5

  8. % Preterm Birth (PTB): 2004-2008 PTB=births before 37 completed gestational weeks African-Americans Georgia: 17.5 SWHD: 17.9 Baker: 25.0 Calhoun: 18.5 Dougherty: 17.6 Lee: 15.2 Mitchell: 19.4 Terrell: 19.8 Worth: 18.7 Caucasians Georgia: 11.7 SWHD: 13.6 Baker: 8.6 Calhoun: 13.8 Dougherty: 13.8 Lee: 13.4 Mitchell: 14.7 Terrell: 18.1 Worth: 17.7

  9. Steps Towards Centering Developed the care delivery concept and applied for start-up funding Selected centering team Developed protocols including exclusion criteria Team training Staff preparation Centering Health Institute Made the case for centering with collaborating practices and partners Purchased equipment, supplies Mastered Scheduling

  10. Collaborating Practices and Partners Albany Area Primary Healthcare (Miriam Worthy Clinic) Veranda Ob/Gyn Phoebe Family Practice Residency Program Phoebe Putney Memorial Hospital (childbirth/lactation and maternal outreach educators) Karen Ryals, independent yoga instructor Centering Health Institute March of Dimes Healthcare Georgia Foundation

  11. Why Centering? Evidenced-based model of group prenatal care Study participants with similar demographics Assessment (prenatal care) Education Support Empowerment through knowledge and building skills March of Dimes support

  12. Essential Elements of Centering Women involved in self-care The “check-up” occurs within the group space The group session is conducted in a circle Group session not a class with an overall plan Every person’s contribution adds to richness of group Groups have 6-10 members all due within 4 weeks Two hour sessions at routine prenatal care interval Stability of group leadership

  13. Self-Care • Women do self-monitoring of weight & blood pressure • Calculate weeks of pregnancy • Write in personal chart “I love the fact that I get a lot of hands on experience” Centering patient

  14. The Prenatal Check-up • Individual physical assessment within group space • Done by a licensed healthcare provider “This is the first time in my life that I actually look forward to going to the doctor” Centering patient

  15. Educational Sessions • Facilitated sessions • Fun and Interactive • Everyone participates “We learn more about what’s going on with our baby than we would be at a regular ob/gyn” Centering patient

  16. Educational Sessions • Nutrition and infant feeding • Oral health • Prenatal yoga for stress reduction

  17. Educational Sessions • Family planning • Birth preparation and recovery • Newborn care

  18. Support Centering patient I like “having the company of other pregnant women around my age group that I can share my experience with”

  19. Dougherty County CenteringPregnancy® The DATA AS of 8/23/12

  20. New Obstetrical Examination 227 new obstetrical (NOB) examination visits Mean gestational age at NOB: 11 weeks Mean maternal age at NOB visit: 22.4 year Maternal age range: 13-44

  21. Maternal Characteristics: Race

  22. Maternal Characteristics: Ethnicity

  23. Maternal Characteristics: Marital Status

  24. Maternal Characteristics of CenteringPregnancy® Patients

  25. Maternal Characteristics: Insurance

  26. Maternal Characteristics: Medical • Majority nulliparous • Slightly less than 3% had a prior preterm birth • 25% were treated for sexually transmitted infections • 19% reported tobacco use and 10% tested positive for marijuana • Nearly a third were anemic • 18% were treated for asymptomatic bacteriuria • 5.6% reported depression • 4.5% had sickle cell trait • 6.1% developed gestational diabetes

  27. Percent of Patients Attending No Sessions N=64

  28. Percent of Centering Patients Attending<3 Sessions

  29. Delivery Outcomes Centering: 2009- Georgia : 2008-2010

  30. Delivery Outcomes: Preterm Birth %

  31. Delivery Outcomes: Low Birth Weight %

  32. Breastfeeding Initiation Rates Centering Patients Dougherty County WIC

  33. Patient Feedback • Average program rating: 9.5, scale of 1-10 • Men in the group? 96% said yes • Rather have visit conducted in an exam room? • 89% said yes • 9% said no • 2% said either • 97% said they learned a lot about prenatal care • 93% felt they were well prepared for labor and delivery • 91% felt they were prepared to take care of their newborn

  34. District 8-2 Centering Staff Jacqueline H. Grant, MD, MPH, MPA Karen Baker, F-NP VaLenia Milling, RN Denise Linnekohl, RN, BSN Nancy Rumph, administrative assistant Nettie Lilly, clerical/outreach worker Sarah Shriver, WIC nutritionist Lisa Malmquist, CNM (contract) Vanessa Jones, F-NP Christina Montelongo, program assistant/interpreter Sheena Hargraves, LPN (interpreter) Lupe Meade, LPN (interpreter) Sharonda Barlow, MSW

  35. Questions or Comments?

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