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Valenciamillercentering pregnancy program
 

Valenciamillercentering 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

Valenciamillercentering pregnancy program Valenciamillercentering pregnancy program Presentation Transcript

  • CENTERINGPREGNANCY® PROGRAM IMPROVING ACCESS AND OUTCOMES IN THE SOUTHWEST HEALTH DISTRICT
  • DISTRICT AND CENTERING CATCHMENT AREA Ware Burke Clinch Hall Laurens Early Lee Bulloch Floyd Wayne Charlton Fulton Long Coffee Worth Emanuel Polk Screven Dodge Troup Carroll Decatur Camden Bryan Grady Harris Dooly Cobb Glynn Brooks Wilkes Colquitt Liberty Thomas Appling Gilmer Jones Bartow Rabun Irwin Sumter Echols Fannin Tift Coweta Telfair Walker Union Macon Mitchell Taylor Lowndes Elbert Tattnall Berrien Washington Talbot Bibb Hancock Baker Greene Jasper Stewart Monroe Upson Wilcox Crisp Pierce Pike Brantley Marion Henry Jefferson Hart Twiggs Clay Gordon Gwinnett Putnam Murray Heard Cook Miller Toombs Randolph Bacon Morgan Terrell Effingham Walton Wilkinson Jenkins McIntosh Cherokee Houston Chatham Meriwether Jackson Turner Banks Paulding Oglethorpe Atkinson Johnson White Pulaski Calhoun Baldwin Warren Lincoln Newton Lumpkin Richmond Madison Wheeler Crawford Columbia De Kalb Butts Candler Franklin Evans Haralson Dougherty Lamar Lanier Chattooga Pickens Ben Hill Forsyth Jeff Davis Towns Whitfield Dawson Seminole Douglas Bleckley Oconee Schley Habersham Fayette Barrow Spalding Catoosa Treutlen Muscogee Mont- gomery Taliaferro Quitman Glascock Chatta-hoochee Clayton Rockdale Stephens McDuffie Clarke Peach Webster Dade 8-1 9-2 7 5-1 9-3 5-2 6 10 2 1-2 1-1 3-1 4 3-4 3-23-5 9-1 3-3 8-2 Georgia Public Health Districts 1-1 Northwest (Rome) 1-2 North GA (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 East Metro 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens)
  • 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
  • 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
  • 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
  • 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
  • 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
  • BASELINE OUTCOMES
  • 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
  • Breastfeeding Initiation Rates 39% 61% Dougherty WIC 2008 Breast Artificial 55% 45% Colquitt WIC 2011 Breast Artificial
  • Centering Data
  • 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
  • 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
  • Breastfeeding Initiation Rates Dougherty Centering Dougherty WIC-FY 2014 75% 25% Breast feeding Formula 51% 49% Breast feeding Formula
  • Breastfeeding Initiation Rates Ellenton Centering Colquitt WIC-FY 2014 75% 25% Breast feeding Formula 65% 35% Breast feeding Formula
  • 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
  • Access to telemedicine allows ultrasounds and Maternal Fetal Medicine consults to be done on-site
  • 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.
  • Southwest Health District CenteringPregnancy™ Program: A patient-centered model for prenatal care that is expanding access to comprehensive care and is making a difference!
  • QUESTIONS?