Centering pregnancy program

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  • Program purpose: To improve access to care and perinatal outcomes in low income African-American and Hispanic women in Southwest Georgia
  • T
  • The five year rolling data. Baseline is the data before the start of the program- this is the data we were looking at to determine needs.
  • PTB=births before 37 completed gestational weeks, Nationally the preterm birth rate was 12.8% in 2006 and it was 18.4% for Blacks in 2006*LBW %= % of births <2500 grams
  • N=136 patients DoughertyN= 78, but if add in patient who had inevitable SAB (only attended one session) and maintain pregnancy then PTB 10.1%
  • N=136 Dougherty N=75 Ellenton

Transcript

  • 1. CENTERINGPREGNANCY® PROGRAM IMPROVING ACCESS AND OUTCOMES IN THE SOUTHWEST HEALTH DISTRICT
  • 2. DISTRICT AND CENTERING CATCHMENT AREA W are Burke C linc h H all Laurens Early Lee Bulloch Floyd W ayne C harlton Fulton Long C offee W orth Em anuel Polk Screv en D odge Troup C arroll D ecatur C am den Bryan Gr ady H arris D ooly C obb Gly nn Brooks W ilk es C olquitt Liber ty Thom as Appling Gilm er Jones Bartow R abun Irw in Sum ter Echols Fannin Tift C ow eta Telfair W alk er U nion M acon M itchell Tay lor Low ndes Elbert Tattna ll Berrien W ashington Talbot Bibb H ancock Baker Gr eene Jasper Stew art M onroe U pson W ilc ox C risp Pierce Pike Brantley M arion H enry Jefferso n H art Tw iggs C lay Gor don Gw inn ett Putnam M urray H eard C ook M iller Toom bs R andolph Bacon M organ Terr ell Effingham W alton W ilk inson Jenkins M cIntosh C herokee H ouston C hatham M eriwether Jacks on Turner Banks Paulding Oglethorpe Atkinson Johnson W hite Pulaski C alhoun Baldw in W arren Linc oln N ew to n Lum pkin R ichm ond M adison W heeler C raw ford C olum bia D e K alb Butts C andler Frank lin Evans H aralson D ougherty Lam ar Lanier C hattooga Pickens Ben H ill Fors yth Jeff D avis Tow ns W hitfield D aw son Seminole D ouglas Bleckley Oc onee Schley Habersham Fay ette Barrow Spalding C atoos a Treutlen M usc ogee Mont- gomery Taliaferro Quitm an Glas cock Chatta-hoochee Clayton Rockdale Ste p hens McDuffie Clark e Pea ch W ebste r Dad e 8-1 9-2 7 5-1 9-3 5-2 6 10 2 1-2 1-1 3-1 4 3-4 3-2 3-5 9-1 3-3 8-2 Georgia Public H ealth D istricts 1-1 N o rth w e st (Ro m e) 1-2 N o rth G A (D a lto n ) 2 N o rth (Ga in esville) 3-1 C o bb -Do u g la s 3-2 F u lto n 3-3 C la yto n 3-4 E a st M et ro 3-5 D e Ka lb 4 L a Gra n g e 5-1 S o u th C en tr al (Du b lin ) 5-2 N o rth C e nt ral (M a c o n ) 6 E a st C e n tra l (A u g usta ) 7 W e st C e ntr al (C olu m b u s) 8-1 S o u th (V a ld o sta ) 8-2 S o u thw e st (Alb an y) 9-1 C o asta l (Sa va n n ah ) 9-2 S o u the a st (W a yc ro ss) 1 0 N o rth ea st (A th e ns)
  • 3. Problem Being Addressed • Barriers to early access to prenatal care for low-income women ▫ African-American women  14 county predominantly rural district, many counties no obstetrician  Loss of three high-volume OB/GYN Medicaid providers in Dougherty, 2008  Dougherty County: 64% African-American  Dougherty County accounts for a third of the district’s population  Presumptive eligibility for pregnancy Medicaid not accepted by most obstetricians in Dougherty County ▫ Hispanic women  The District’s southernmost counties are agricultural hubs  Colquitt County’s Hispanic population estimated at 14% - probably significantly under-estimated due to a large number of undocumented Hispanic farm workers  Transportation issues  June, 2010 – prenatal care for undocumented low-income Hispanic no longer financed by the Babies Born Healthy (BBH) Program
  • 4. What Is Centering? • National model of group prenatal care • Groups of 6-8 women whose due dates are in the same month • Nine two-hour sessions • Individual assessments • Facilitated discussions • Sessions are fun and interactive • Time for socializing and refreshments • Sessions are held at the same intervals as traditional prenatal care • Monthly until 28 weeks gestation • Every two weeks until 36 weeks gestation
  • 5. What Is Centering? • Support people involved in sessions • Social Worker co-facilitates sessions • More experience with depression, domestic violence and other social issues • More likely to pick up on non-verbal cues related to some of these issues • Patients participate in their prenatal care • Take their own blood pressure • Weigh themselves • Plot and monitor their weight • Wheel out their gestational age
  • 6. Maternal Characteristics: Medical Dougherty County Health Department • Slightly less than 3% had a prior preterm birth • 30% were treated for sexually transmitted infections • 18% reported tobacco use and 15% tested positive for marijuana • Slightly more than a third were anemic • 18% were treated for asymptomatic bacteriuria • 5.5% reported depression • 4.5% had sickle cell trait • 6% developed gestational diabetes
  • 7. Maternal Characteristics: Medical Ellenton Clinic • 12% treated for sexually transmitted infections • None reported tobacco use or tested positive for marijuana • None reported a history of asthma • Over half were anemic • 16% developed gestational diabetes • 4% reported depression
  • 8. BASELINE OUTCOMES
  • 9. District Perinatal Outcomes 2004-2008 0.0% 5.0% 10.0% 15.0% 20.0% % PTB % LBW 18.2% 15.7% 13.7% 8.4% 12.1% 6.8% NH Blacks NH Whites Hispanics
  • 10. Breastfeeding Initiation Rates 39% 61% Dougherty WIC 2008 Breast Artificial 55% 45% Colquitt WIC 2011 Breast Artificial
  • 11. Centering Data
  • 12. Pre-term Birth Rates 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0% 8.8% 9.0% 12.1% 13.7% 18.2% Dougherty Centering Ellenton Centering District Hispanics District NH Whites District NH Blacks
  • 13. Low Birth Weight Rates 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 5.3% 6.8% 8.4% 11.8% 15.7% Ellenton Centering District Hispanic District NH Whites Do Co Centering District NH Blacks
  • 14. Breastfeeding Initiation Rates Dougherty Centering Dougherty WIC-FY 2014 75% 25% Breast feeding Formula 51% 49% Breast feeding Formula
  • 15. Breastfeeding Initiation Rates Ellenton Centering Colquitt WIC-FY 2014 75% 25% Breast feeding Formula 65% 35% Breast feeding Formula
  • 16. CenteringPregnancy®: Expanding Services Through the Use of Telemedicine * Better coordination of services * Easier access to subspecialists: • Maternal –Fetal Medicine • Cardiologist • Mental and Behavioral Health • Dermatologist
  • 17. Access to telemedicine allows ultrasounds and Maternal Fetal Medicine consults to be done on-site
  • 18. Through a partnership with Women’s Telehealth in Atlanta, Dr. Anne Patterson is introduced to each Centering group and included in facilitated discussions in sessions on pre-term labor and gestational diabetes via the telemedicine cart.
  • 19. Southwest Health District CenteringPregnancy™ Program: A patient-centered model for prenatal care that is expanding access to comprehensive care and is making a difference!
  • 20. QUESTIONS?