CenteringPregnancy(TM) Implementation and its Effect on Preterm Birth and Low Birthweight

CenteringPregnancyTM Implementation and its Effect on Preterm Birth and Low Birthweight by Carole Ann Moleti MPH, Columbia University, 1987 MS, Columbia University, 1986 BS, Herbert H. Lehman College, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 Abstract Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancyTM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancyTM program implementation plan, customized to meet the needs of a multisite urban hospital system, was coordinated with the Centering Healthcare Institute to ensure method fidelity while allowing for an individual site's needs based upon patient demographics and provider mix. Program evaluation showed that the logic models supported implementation and expansion of Centering Groups at 2 federally qualified health centers, with adequate progress toward site approval, method fidelity scores, and favorable patient and staff satisfaction ratings using the CenteringCountsTM data collection system. After a total of 4 Centering group cohorts with 26 women, 7 at high medical risk, 4 delivered preterm (11.5%), 2.3% less than the institutional average PTB rate of 13.8%. One out of 26 women delivered a LBW infant. Twenty-two of 24 women (92%) initiated breastfeeding compared to the institutional average of 89%. To foster a change in policy toward Centering as the default option for prenatal care, ongoing evaluation is required to assess the reduction of and fiscal impact on preterm and low birthweight rates to offset the cost of implementation.Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancyTM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancyTM program implementation plan, customized to meet the needs of a multisite urban hospital system, was coordinated with the Centering Healthcare Institute to ensure method fidelity while allowing for an individual site's needs based upon patient demographics and provider mix. Program evaluation showed that the logic models supported implementation and expansion of Centering Groups at 2 federally qualified health centers, with adequate progress toward site approval, method fidelity scores, and favorable patient and staff satisfaction ratings using the CenteringCountsTM data collection system. After a total of 4 Centering group cohorts with 26 women, 7 at high medical risk, 4 delivered preterm (11.5%), 2.3% less than the institutional average PTB rate of 13.8%. One out of 26 women delivered a LBW infant. Twenty-two of 24 women (92%) initiated breastfeeding compared to the institutional average of 89%. To foster a change in policy toward Centering as the default option for prenatal care, ongoing evaluation is required to assess the reduction of and fiscal impact on preterm and low birthweight rates to offset the cost of implementation. CenteringPregnancyTM Implementation and its Effect on Preterm Birth and Low Birthweight by Carole Ann Moleti, CNM, FNP-BC MPH, Columbia University, 1987 MS, Columbia University, 1986 BS, Herbert H. Lehman College, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 Dedication This project was undertaken for one reason: the women of The Bronx. Caring for them, despite all the complexities and difficulties, has brought me the greatest joy and fulfillment imaginable. Their smiles, hugs, tears, and trust have kept me going through those long sleepless nights and hectic days. My thoughts often reach out to great-grandmother Jennie Bruno, who delivered babies for the women of The Bronx in the early 1900s when mothers and babies routinely died. And to my grandfather, Alexander Bruno, who passed her talent, her legacy, and her instruments to me. To my husband John, my sons Nicholas and Adam, and my daughter Maya who put up with the crazy schedules and phone calls in the middle of the night. And to Michael and my parents who encouraged me from the very beginning to accept the call, along with the challenges answering it would bring. Acknowledgments This project is the culmination of more than 2 decades of work that began with the kind offer of a public health internship from Nancy DeVore, CNM, MS. The years that ensued in the midwifery practice at Jacobi Hospital were some of the happiest of my career, with treasured memories and enduring friendships. The influence of mentors like Nancy and Margaret Comerford Freda, EdD, RN, CHES, with whom I worked with at Einstein's Program to Reduce Obstetrical Problems and Prematurity (PROPP), has come full circle and back to the basics with CenteringPregnancyTM, the intervention that just might be the answer we've been looking for all these years. Thanks go out to my longtime midwifery partner Susan Bellinson, CNM, MS for her willingness to help with this project, and Peter Bernstein, MD, MPH for his enthusiasm and support of the research process. Sharon Schindler Rising, CNM, MS, FACM and the entire team at Centering Healthcare Institute as well as at Montefiore's Comprehensive Family Care Center and Family Health Center welcomed and supported the planning and implementation of the Centering expansion that preceded data collection and analysis. Special mention is due Rebecca Mahn who, despite the rigors and time constraints of medical school, has remained deeply involved and committed to CenteringPregnancyTM as the twenty-first century's answer to stubborn problems and disparities that affect women and children. I am immensely grateful for all the teamwork, dedication, and support needed to do this work, which can be so difficult and complex.