# Presentation: 122160

## Addressing Disparities in Perinatal Health Using a Collaborative Approach: The PCC Community Wellness Center’s Experience 

May 17, 2006

Mark Loafman, M.D., M.P.H.
Andrea McGlynn, C.N.M., M.S.N.
Chicago, IL

- May 17, 2006
- Mark Loafman, M.D., M.P.H.
- Andrea McGlynn, C.N.M., M.S.N.
- Chicago, IL

## PCC Highest Areas of Patient Population

## Austin Community Selected Demographic/Health Data*

- Chicago Department of Public Health – Chicago Health and Health Systems Project April 2006
- 	2000 Census Data

**Percent of Population**

## Austin vs. Chicago Infant Mortality 2003

**Austin vs. Chicago Infant Mortality 2003**

**Austin vs. Chicago Selected Perinatal Indicators 2003**

**Rate/1000 Live Births**

**Percentage**

- Source: 	Chicago Department of Public Health – Chicago Health and Health Systems Project April 2006

## Overview of PCC

- History and mission
- Full-service community health center since 1993
- 330 funding (FQHC) since 2002
- Model of care
- Family Medicine
- 9 of 18 Attendings with MCH/OB Fellowship
- Peds, OB/GYN, CNMs, FNPs, LCSWs, Psych
- Health education and outreach
- Hosts MCH Fellowship and FM Residents
- Experience with health disparities collaboratives

**Notes:**
... is a post-residency clinical training program that emphasizes:
 women’s health maintenance and family planning
 prenatal risk reduction and community based care
 family centered birthing as well as active labor management and operative obstetrics
neonatology (Level II) and follow-up care for the high risk neonate
pediatrics including developmental follow-up, early intervention, inpatient care, and outpatient pediatrics emphasizing the urban underserved. 
MCH Fellows are Attending Physicians in the outpatient setting.

## PCC UDS Data

| Year | Total Users | Prenatal Users | Deliveries | % LBW | % Late Entry to Care | HIV+ Prenatal Users |
| --- | --- | --- | --- | --- | --- | --- |
| 2002 | 11,359 | 737 | 445 | 15% | 8% | 0 |
| 2003 | 20,928 | 858 | 647 | 15% | 20% | 1 |
| 2004 | 22,653 | 1779 | 1083
(836 PN users) | 8% | 44% | 2 |
| 2005 | 25,235 | 2086 | 1395
(1064 PN users) | 9.7% | 42% | 3 |

## Care Model

## Impact Analysis of PCC’s Model

- *	Austin area, 1999.  Source: I-PLAN data system
- **	RSWH deliveries of PCC and unattached patients, 6-11/2004 Source: Perinatal database.

**FAMILY PRACTICE MODEL WITH OBSTETRICS**

**Low birthweight (140/1,000 live births)***
**Very low birthweight (39/1,000 live births)***

**Low birthweight (101/1,000 live births)****
**Very low birthweight (9/1,000 live births)****

**Family Practice Residency           MCH Fellowship **
**Case Management **
**Community Nursing  **
**AmeriCorps Outreach Workers**

**CLINICAL MODEL**

**Outcome**

**Community Problem**

## Perinatal Pilot Collaborative 

**Opportunities to positively influence MCH**

**PCC and Partners**

**Maternal preconception health**

**Environment**

**Genetic/familial**
**life course**

**Lifestyle/stressors/**
**stress response**

**SES conditions & disparities**

**Prenatal course**

**Early and individualized risk assessment and care**

**Concurrent & prospective care management**

**Networks & collaborations**

**Access to ongoing health care**

**Educational & economic opportunities **

**Environmental **
**safety**

**Psychological & spiritual support services**

**Social & legal resources**

- Perinatal Pilot Collaborative

- Seeing wider opportunities to respond to the problem

**Influences on MCH**

## Example: Ramp-up of PDSAs

- 				Outreach to patients
- Refined tracking form	(follow-up needed)
- 		Patient given specific contact person for appt.
- 				(barriers to appointment)
- 		Algorithm to prompt care/red folders
- 			(more comprehensive approach)
- GDM screening at hospital OB triage

- Plan-Do-Study-Act Method of Making Changes

- Identify opportunity, then champion the idea
- PDSA changes (> 119 PDSAs in Perinatal Pilot at PCC)

## Top 7 Changes

- _At the Health Center_
- Front-loaded care
- Prenatal sessions for all FP providers
- Psychosocial and depression screening (PHQ)
- Self-management goals
- Performance Improvement assistant (PIA) role

- _At the Hospital_
- “Red folders” algorithm/outreach to unattached patients
- Joint practice committee: pre-M&M quality assurance

## Perinatal PECS Data at PCCJuly 2005 to Present

- _Process (as of 4/06)*_
- HIV test (100%)
- Psychosocial risk assessment (83%)
- Prenatal depression screening (78%)
- SMG (50%)
- Early GDM screening (80%)

- _Outcome (7/05 to 3/06)*_
- Preterm labor (13%)
- Low birthweight (13%)
- Infant mortality (0)

**CHALLENGES**

- *	at pilot site only – selected indicators

## Performance Improvement Program

- Identified Needs

## Communication and Systems Development 

- How do you measure that? Existence of...
- Processes developed and “institutionalized”
- Extend care management model into hospital
- Evidence-based practice tools – algorithms, protocols, drills

**Excerpt from PCC’s Perinatal Collaborative Aim Statement:**
** “...****implementation of a patient safety system that prepares the multidisciplinary PCC and WSMC teams for high-risk patient care (antepartum, intrapartum, and postpartum) and encourages self-reporting and identification of ‘near misses’ by November 2005 at PCC and WSMC Family Birthplace.”**

## PCC Community Wellness Center/West Suburban Medical Center

## Closing the Gap Programs in Chicago

**Health Resources and Services Administration (HRSA)**
- Closing the Health Gap Initiative on Infant Mortality

**Maternal and Child Health Bureau (MCHB)**
**Risk Reduction Pilot**

**Bureau of Primary Health Care (BPHC)**
**Perinatal and Patient Safety**
**Pilot Health Disparities Collaborative**

**State MCH agencies and other grantees**

**Perinatal collaborative pilot sites, then all FQHCs**

**Target population reached by risk reduction outreach**

**Target Population that accesses prenatal care**

## Still More Needed to Close the Gap

*...**and address social, economic, environmental disparities*

**Health Resources and Services Administration (HRSA)**
- Closing the Health Gap Initiative on Infant Mortality

**Maternal and Child Health Bureau (MCHB)**
**Risk Reduction Pilot**

**Bureau of Primary Health Care (BPHC)**
**Perinatal and Patient Safety**
**Pilot Health Disparities Collaborative**

**State MCH Agencies and Other Grantees**

**FQHCs (perinatal collaborative pilot sites then all FQHCs**

**State MCH Agencies and Other Grantees**

**Target Population that accesses prenatal care**

**Unreached target population **
**high-risk for infant mortality, **
**only accesses emergency services**

## PCC’s Plans for Collaborative Spread

- To other PCC sites
- Unattached population
- Assist in spread to other FQHCs nationally

## More Plans

- _Research to Better_
- _Understand:_
- Role of prenatal care in improving outcomes
- Improved psychosocial screening and health
- Workforce development
- Model replication

- _Integration of Services_
- WIC/Case management together with CHC services
- Behavioral health
- Community-based agencies