Date post: | 13-Nov-2014 |
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CENTERINGPREGNANCY® PROGRAM
IMPROVING ACCESS AND OUTCOMES IN THE SOUTHWEST HEALTH DISTRICT
DISTRICT AND CENTERING CATCHMENT AREA
Ware
Burke
Clinch
Hall
Laurens
Early
Lee
Bulloch
Floyd
Wayne
Charlton
Fulton
LongCoffeeWorth
Emanuel
Polk
Screven
Dodge
Troup
Carroll
DecaturCamden
Bryan
Grady
Harris
Dooly
Cobb
Glynn
Brooks
Wilkes
Colquitt
Liberty
Thomas
Appling
Gilmer
Jones
Bartow
Rabun
Irwin
Sumter
Echols
Fannin
Tift
Coweta
Telfair
WalkerUnion
Macon
Mitchell
Taylor
Lowndes
Elbert
Tattnall
Berrien
Washington
TalbotBibb
Hancock
Baker
Greene
Jasper
Stewart
MonroeUpson
WilcoxCrisp
Pierce
Pike
Brantley
Marion
Henry
Jefferson
Hart
Twiggs
Clay
Gordon
Gwinnett
Putnam
Murray
Heard
CookMiller
Toombs
RandolphBacon
Morgan
Terrell
Effingham
Walton
Wilkinson Jenkins
McIntosh
Cherokee
Houston
Chatham
Meriw
ether
Jackson
Turner
Banks
Paulding Oglethorpe
Atkinson
Johnson
White
Pulaski
Calhoun
Baldwin
Warren
Lincoln
Newton
Lumpkin
Richmond
Madison
Wheeler
Crawford
Columbia
De Kalb
Butts
Candler
Franklin
Evans
Haralson
Dougherty
Lamar
Lanier
Chattooga Pickens
Ben Hill
Forsyth
Jeff Davis
Towns
Whitfie
ld
Dawson
Semi
nole
Douglas
Bleckley
Oconee
Schley
Habe
rsh
am
Fayette
Barrow
Spalding
Catoosa
TreutlenMuscogee
Mont-
gome
ry
Taliaferro
Quitman
Glascock
Chatt
a-ho
oche
e
Clayton Rock
dale
Stephens
McDu
ffie
Clarke
Peach
Webster
Dade
8-19-2
7 5-1
9-3
5-26
10
2
1-2
1-1
3-1
4
3-43-23-5
9-1
3-3
8-2
Georgia Public Health Districts1-1 Northwest (Rome)1-2 North GA (Dalton) 2 North (Gainesville)3-1 Cobb-Douglas3-2 Fulton3-3 Clayton3-4 East Metro3-5 DeKalb 4 LaGrange5-1 South Central (Dublin)5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus)8-1 South (Valdosta)8-2 Southwest (Albany)9-1 Coastal (Savannah)9-2 Southeast (Waycross) 10 Northeast (Athens)
Problem Being Addressed• Barriers to early access to prenatal care for low-income women
▫ African-American women 14 county predominantly rural district, many counties no
obstetrician Loss of three high-volume OB/GYN Medicaid providers in
Dougherty, 2008 Dougherty County: 64% African-American Dougherty County accounts for a third of the district’s population Presumptive eligibility for pregnancy Medicaid not accepted by most
obstetricians in Dougherty County
▫ Hispanic women The District’s southernmost counties are agricultural hubs Colquitt County’s Hispanic population estimated at 14% - probably
significantly under-estimated due to a large number of undocumented Hispanic farm workers
Transportation issues June, 2010 – prenatal care for undocumented low-income Hispanic
no longer financed by the Babies Born Healthy (BBH) Program
What Is Centering?• National model of group prenatal care• Groups of 6-8 women whose due dates are in the
same month• Nine two-hour sessions
• Individual assessments• Facilitated discussions
• Sessions are fun and interactive• Time for socializing and refreshments• Sessions are held at the same intervals as
traditional prenatal care• Monthly until 28 weeks gestation• Every two weeks until 36 weeks gestation
What Is Centering?• Support people involved in sessions• Social Worker co-facilitates sessions
• More experience with depression, domestic violence and other social issues
• More likely to pick up on non-verbal cues related to some of these issues
• Patients participate in their prenatal care• Take their own blood pressure• Weigh themselves• Plot and monitor their weight• Wheel out their gestational age
Maternal Characteristics: Medical
Dougherty County Health Department•Slightly less than 3% had a prior preterm birth•30% were treated for sexually transmitted
infections•18% reported tobacco use and 15% tested
positive for marijuana •Slightly more than a third were anemic•18% were treated for asymptomatic bacteriuria•5.5% reported depression•4.5% had sickle cell trait•6% developed gestational diabetes
Maternal Characteristics: Medical
Ellenton Clinic•12% treated for sexually transmitted
infections•None reported tobacco use or tested positive
for marijuana •None reported a history of asthma•Over half were anemic•16% developed gestational diabetes•4% reported depression
Historical Perinatal Data
BASELINE OUTCOMES
District Perinatal Outcomes 2004-2008
% PTB % LBW0.0%2.0%4.0%6.0%8.0%
10.0%12.0%14.0%16.0%18.0%20.0% 18.2%
15.7%13.7%
8.4%
12.1%
6.8%NH BlacksNH WhitesHispanics
Breastfeeding Initiation Rates
39%61%
Dougherty WIC 2008
BreastArtificial
55%45%
Colquitt WIC 2011
BreastArtificial
Southwest Health District
Centering Data
Pre-term Birth Rates
Series10.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
8.8%
9.0%
12.1%
13.7%
18.2%
Dougherty CenteringEllenton CenteringDistrict HispanicsDistrict NH WhitesDistrict NH Blacks
Low Birth Weight Rates
Series10.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
5.3%
6.8%
8.4%
11.8%
15.7%
Ellenton CenteringDistrict HispanicDistrict NH WhitesDo Co CenteringDistrict NH Blacks
Breastfeeding Initiation Rates
Dougherty CenteringDougherty WIC-FY 2014
75%
25% Breast feedingFormula
51%49%Breast feedingFormula
Breastfeeding Initiation Rates
Ellenton Centering
Colquitt WIC-FY 2014
75%
25% Breast feeding
Formula 65%
35% Breast feedingFormula
CenteringPregnancy®: Expanding Services Through
the Use of Telemedicine
* Better coordination of services
* Easier access to subspecialists:• Maternal –Fetal Medicine• Cardiologist• Mental and Behavioral Health• Dermatologist
Access to telemedicine allows ultrasounds and Maternal Fetal Medicine consults to be done on-site
Through a partnership with Women’s Telehealth in Atlanta, Dr. Anne Patterson is introduced to each Centering group and included in facilitated discussions in sessions on pre-term labor and gestational diabetes via the telemedicine cart.
Southwest Health District CenteringPregnancy™ Program:
A patient-centered model for prenatal care that is expanding access to comprehensive
care and is making a difference!
QUESTIONS?