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  1. 1. Rural Health Care ConferenceCenteringPregnancy® Model for Prenatal Care Sara Long Dec. 8, 2011
  2. 2. Centering Pregnancy Model for Prenatal Care Thirteen essential elements define the Centering model of care
  3. 3. 1. Health assessment occurs within the group spaceCare is normalized Privacy is assured
  4. 4. 2. Participants are involved in self-care activities
  5. 5. 3. A facilitative leadership style is used
  6. 6. 4. Each session has an overall plan Comfort & Birth Preparation Safety Infant Development Stress Reduction Nutrition & Infant Feeding
  7. 7. 5. Attention is given to the generalcontent outline; emphasis may vary “I’m learning that it doesn’t matter what we don’t talk about because we’re talking about what matters to the group”
  8. 8. 6. There is stability of group leadership Continuity of care TrustGroup history
  9. 9. 7. Group conduct honors thecontribution of each member
  10. 10. 8. The group is conducted in a circle
  11. 11. 9. Opportunity for socializing is provided
  12. 12. 11. Group size is optimal to promote the process
  13. 13. 12. Involvement of support people is optional
  14. 14. 13. There is ongoing evaluation of outcomesAnything we want to see improved….benchmarking Patient experience Attendance for prenatal care visits Breastfeeding rates Birth outcomes – gestational age and birth weight96-97% of all women polled state they preferreceiving their prenatal care in group
  15. 15. References:Ickovics JR, Kershaw TS, Westdahl C et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics & Gynecology. 2007; 110(2):330-339.Cooper LG, LMSW; Gooding JS, BS; Gallagher J, RN, EdM, MPA; Sternesky L, MPA, Ledsky R, MBA; and Berns SD, MD, MPH. Impact of a family-centered care initiative on NICU care, staff and families. Journal of Perinatology 2007; 27: S32-S37Grol, R., & Grimshaw, J. . From best evidence to best practice: effective implementation of change in patients’ care. The Lancet 2003; 362, 1225-1230.Peterson AA, Berns SD, Gooding JS, et al. Meeting the Needs of Pregnant Women and Babies in a Disaster: The Role of Voluntary Nongovernmental Health Organization. Journal of Emergency Management 2007;5(1):41-46.
  16. 16. Words from the Wise* Success factors in sustaining groups: 1. Dedicated, appropriate space 2. Committed administration support (including line-items in the budget) 3. Centering coordinator with released administrative time 4. Commitment to “opt-out”*Sharon Rising, CNM, MSN, Executive Director, CHI
  17. 17. Centering Healthcare Institute 1. Centering Site Readiness Visit 2. Initial Training 3. Reporting forms 4. Consultation on system re-design 5. Site visit and approval
  18. 18. 558 Maple Avenue Cheshire, CT 06410
  19. 19. Success factors in management & fundingLancet: From best evidence to best practice: – Identifies 11 frequently used interventions, 4 directly relevant to Centering Pregnancy: • Educational strategies • Multi-professional collaboration • Patient-mediated interventions • Combination of interventions
  20. 20. Success factors in management & funding What do funders want: • Outcomes • Visibility/Recognition • Outcomes • SMART Objectives • Outcomes • Sustainability Plan
  21. 21. March of Dimes InvolvementOur goal: in Virginia, to reduce preterm birth rates, especially among pregnant population at high risk of preterm birth.1. Increase the number of sites and providers offering CP.2. Improving fidelity of CP delivery to the essential elements of the model.3. Enrolling more pregnant women in CP.4. Maintain women’s satisfaction with care.
  22. 22. 2008 March of Dimes chapter-funded Centering Pregnancy® grants – In Blue WA MT ME ND VT OR MN NH MA ID WI NY SD WY MI RI CT IA PA NJ NV NE OH DE IL IN UT CO WV MD VACA KS MO DC KY NC TN AZ OK AR SC NM MS AL GA TX LA FL AK HI
  23. 23. Assessment of MOD-funded projects1. Expand National Office and chapter collaboration to develop, deploy, and evaluate CP training, TA tools, and models and to disseminate information about CP successes to stakeholders.2. Build informal networks of providers at the chapter level, to engender peer-to-peer learning.3. Develop MOD website(s) that provide access to extensive information about ongoing TA and coordination effects; evaluation findings; and funding opportunities.4. Advance CP evaluation by standardizing indicators, data collection tools, and reporting formats.
  24. 24. March of Dimes survey of CP providers identifiedthese top sustainability success factors: Planning, beginning in the first year Staff buy-in Funding – external and internal Enrollment Evaluation -- process and outcome
  25. 25. March of Dimes funding• Provide funding for basic and advanced provider training workshops;• CP site infrastructure, materials, supplies, and staff; and• Provision of coordination and technical assistance, including assistance with evaluation.
  26. 26. Reporting required for MOD funding1. Patient demographics.2. Patient attendance.3. Date of first session.4. Patient satisfaction/self-evaluation.5. Fidelity of CP core elements.6. Outcome Variables.
  27. 27. Long-term commitment1. Provide support for mature sites for ongoing staff training.2. Work with grantees to ensure sustainability.3. Support TA assistance and coordination for CP sites.4. Support and/or collaborate in research efforts that examine benefits, cost neutrality, and/or cost effectiveness of CP, and help to disseminate the findings to diverse stakeholders.5. Advocate directly for additional support for CP with other public and private funders, policymakers, insurance companies, and others.
  28. 28. Virginia ProjectsVCUFamily Maternity Center of the Northern NeckSouthern Dominion Health System, Inc.Johnson Health ServicesSt. Francis Family Medicine CenterEastern Virginia Medical SchoolRiverside Family PracticeAugusta Health Care for WomenCommunity Memorial HealthcareThree Rivers Health DistrictRichmond City Health DistrictHolston Medical GroupShenandoah Women’s HealthcareSouthampton Memorial HospitalManassas Midwifery
  29. 29. March of Dimes• Funding ($3,000 - $35,000)• Consultation and TA• Advanced Training by CHI• CP Peer to Peer Network
  30. 30. Q&AFor questions about the modelor funding opportunities, contact: Sara Long (804) 968-4120