Online Program

Population-based prenatal care management services for low income women: Identification of clinical and psychosocial risk factors for preterm birth and other adverse pregnancy outcomes in a pregnancy medical home model

Tuesday, November 5, 2013

Kate Berrien, RN, BSN, MS, Community Care of North Carolina, Raleigh, NC
S. Vienna Barger, MSW, MSPH, CPH, Women's Health Branch, NC Division of Public Health, Raleigh, NC
Background: North Carolina (NC) launched an innovative, new Pregnancy Medical Home (PMH) initiative in April 2011, with an integrated pregnancy care management component provided by local public health departments. A diverse workgroup of stakeholders developed a pregnancy risk screening form, which is completed by the PMH provider at the initial prenatal visit of every Medicaid patient, to determine eligibility for care management. The model aims to improve the quality of maternity care and improve birth outcomes, with a focus on preventing preterm birth.

Methods: Initial pregnancy risk screening forms completed from 12/1/2011 to 12/31/2011 were analyzed for the presence of risk factors. Priority risk factors include: history of preterm birth or low birth weight, multiple gestation, fetal complications, chronic conditions, unsafe living environment, substance use, tobacco use, late entry to prenatal care or missing appointments, hospital utilization, and provider referral.

Results: 3,165 pregnant patients were screened for risk factors. 2,218 (70.1%) had one or more priority risk factors. The most common risk factors were late entry to prenatal care (>14 weeks), (22.7%), current smoker (20.1%), chronic condition (18.9%), and provider referral (16.1%).

Conclusions: At 70.1%, the pregnant Medicaid population with one or more priority risk factors exceeded original planning estimates of 50%. The most common risk factors are both systemic and individual. Barriers to early entry to prenatal care may be more reflective of system challenges for low-income women, whereas smoking is a patient-level concern. Interventions for various risk factors must consider both the patient and the broader care system.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Program planning
Provision of health care to the public
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the primary at-risk population identification mechanism used in North Carolina's Pregnancy Care Management initiative. List the three most prevalent clinical and psychosocial risk factors identified as indicators for pregnancy care management.

Keyword(s): Pregnancy Outcomes, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project manager who oversaw the development and implementation of the Pregnancy Medical Home program for Community Care of North Carolina and currently manage its operations at the state level. I possess a master's of science in Health and Social Behavior from Harvard School of Public Health and a bachelor's of nursing from UNC Chapel Hill. I have experience as an obstetric nurse and in program design and evaluation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.