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Prenatal Care Webinar Luz Jimenez, RN, BSN
VP Clinical Operations
Erie Family Health Center
National Center for Health in Public Housing • The National Center for Health in Public Housing (NCHPH), a
project of North American Management, is supported in part by grant number U30CS09734 from the Health Resources and Services Administration. NCHPH provides training and technical assistance to strengthen the capacity of federally-funded health centers to increase access to health care, eliminate health disparities, and enhance health care delivery for the millions of residents of public and assisted housing.
• The mission of the National Center for Health in Public Housing (NCHPH) is to strengthen the capacity of federally funded Public Housing Primary Care (PHPC) health centers and other health center grantees by providing training and a range of technical assistance.
Facts
34,627 • Number of PHPC
Obstetrician/Gynecologists visits.
536 • Number of visits to PHPC
for perinatal conditions in 2010
Data
Data
Facts
• Transportation
• Lack of health insurance
• Lack of money
• Unable to get appointment when desired
• Unable to take time off work or school
• Lack of childcare for other children
Barriers to accessing prenatal care for pubic
housing women include:
Resources
• Prenatal care and tests
• What is prenatal care and why is it important?
• Barriers to Prenatal Care
• Barriers to Utilization of Prenatal Care for Low Income Women Living in Rhode Island: Impact of the Client-Service Provider Relationship
LUZ J IMENEZ, R N, BSN
S E N I O R V I C E P R E S I D E N T C L I N I C A L
O P E R A T I O N S
E R I E FA M I LY H E A LT H C E N T E R
Facilitating Early Entry into Prenatal Care
with
Women’s Health Promoters
Objectives
Discuss the role of Women’s Health Promoter’s in
achieving early entry into prenatal care
Discuss integration of Women’s Health Promoters
and early prenatal education in the primary care
setting
Discuss management and tracking of prenatal
patients throughout pregnancy
Erie Family Health Center
• Located in Chicago
• Currently 12 sites, 14 as of July 2014
5 School-Based Health Centers
1 Freestanding Adolescent Health Center
6 Primary Care Centers
- 3 dental centers
• 52,168 Unduplicated Users
• >153,000 Visits Annually
• 81% Hispanic; 55% best served in Spanish
Erie Family Health Center
• Payor mix:
• Uninsured 26%
• Medicaid 67%
• Medicare 3%
• Commercial 4%
• Deliveries: 1700
• Quality:
• Early entry into prenatal care - 87%
• Low Birth weight rate - 5.4%
• Breast Feeding at 6mos - 30%
Background
In 2000 Erie began to expand prenatal services, adding
contracted OB/Gyne physicians from partner hospital
to existing midwifery practice
Fail rate among new prenatal patients was 30%
Coordination of Care was limited
Entry into prenatal care 77% in 2004
Demand for prenatal services was high among
uninsured and underinsured population
Need for culturally and linguistically competent care
Background
Women’s Health Promoters were introduced in 2005 as a way to:
Assist pregnant women to establish early prenatal care by facilitating access and providing focused support
Improve no show rate among new prenatal patients
Provide early identification of high risk patients
Provide early referral to supportive health and social services
Provide early prenatal education
Centrally manage patient panels by provider
Gather and record delivery data
Who are Woman’s Health Promoters?
Anyone with an interest in woman’s health, ability to
communicate in the patient’s preferred language,
ability to conduct basic health assessments with
training, collaborative, compassionate and non-
judgmental
Doulas
Health Educators
Nurses
Medical Assistants
AmeriCorp
Integration of Women’s Health Promoters into
the Care Team
First point of contact
Member of the woman’s health care team
Attend team meetings
Manage prenatal panels for delivering
providers
Follow up on transitions of care
Consult with providers as needed
Role and Responsibilities
• Verification of Pregnancy
o Advertised and offered free of charge
o Performed by woman’s health promoter
(WHP) or lab staff who then refer to WHP
o Women with negative result also referred
Role and Responsibilities
• Assessment
Feelings about the pregnancy
Social and Family History
Menstrual and Reproductive History
Physical: height weight, blood pressure, EDD, current health conditions and medications
Smoking Status
Depression Screening (PHQ-2)
Document in the electronic medical record (EMR)
Role and Responsibilities
Education
What to expect during pregnancy
Warning signs of miscarriage
Breastfeeding
Oral health
Prenatal vitamins
Nutrition
Centering Pregnancy group visits
Options counseling
Role and Responsibilities
Administrative
Assign patient to provider based on risk factors – CNM vs. OB/Gyne or Delivering FP
Track and Manage provider caseload
Provide referral for dental care
Provide prenatal packet to patient
Provide referral for WIC
Referral to Case Management
Referral to Patient Benefits Advocate for assistance with enrollment in Medicaid
Entry into Care
Verification of pregnancy
Patient walks-in Lab staff perform test WHP notified or patient scheduled with WHP WHP notifies patient of result Assessment and documentation in EMR Determine appropriate provider Access EDD tracking tool for provider capacity Appointment Education Vitamins Referrals Completes ROI as needed Escorts patient to Case manager CM escorts patient to Patient Benefits Advocate (PBA) for MPE PBA staff escorts to WIC
Entry into Care
New OB Appointment
Patient receives appointment reminder 48 and 24 hours
in advance Patient arrives for appointment MA
intake using pre-visit guidelines for gestational age
Provider Exam Ultrasound Labs Case manager
Front desk schedules next appointment.
Entry into Care
Failed Appointments
PBA sets status of appointment as “failed” PBA
generates “No Show” document in electronic medical
record and routes to provider provider enters follow up
instructions and routes to CM CM contacts patient
and reschedules appointment
Entry into Care
Delivery and Post Partum Care
Patient care summaries generated from EMR and sent
to delivering hospital at 34 weeks
EMR also accessible by provider from L&D
Newborn appointment made before discharge
Delivery data received from hospital and tracked
CM follows mom and baby for 12 months
EDD Tracking
Providers empaneled based on specialty and clinical
FTE
Patients assigned based on high or low risk status and
patient preference where appropriate
WHP updates tracking tool to account for loss of
pregnancy and transitions of care
EDD Tracking
Summary
Women’s Health Promoters can enhance early entry
into prenatal care by serving as the initial point of
contact for pregnant women in Community Health
Centers
Facilitate access and referrals to other critical social
and health care resources
Provide vital education and support
Assist in managing provider empanelment and
monitoring of outcomes
Thank You!
Q&A
• If you would like to ask the presenter a question please submit it through the questions box on your control panel
• If you are dialed in through your telephone and would like to verbally ask the presenter a question, use the “raise hand” icon on your control panel and your line will be unmuted.
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Contact Us Karen Williams Director of Health [email protected]
James Field Deputy Director of Health [email protected]
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