Community Prenatal Case Manager: Linking pregnant women to prenatal care
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Transcript of Community Prenatal Case Manager: Linking pregnant women to prenatal care
Community Prenatal Case Manager: Linking pregnant women to prenatal care
MaryJo Rosazza, RNC, MSPerinatal Health Program DirectorEl Paso County Department of Health and EnvironmentColorado Springs, Colorado
El Paso County Demographics
Population 541,495 8557 births 25% births paid by Medicaid LBW rate 9.6% Pre-maturity rate 9.4%
2002 CDPHE Health Statistics2000 PRAMS data
El Paso County Demographics
11%7%
1% 3%
76.20%
0.2%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
White,non-
Hispanic
White,Hispanic
AfricanAmerican
AmericanIndian/AlaskaNative
Asian Hawaiian/PacificIslander
Background
Safety net role of HD Women’s Clinic
Community Health Center transition to traditional model
Concerns
Prenatal care 1st Trimester 79.6%
No prenatal care1.2%
(CDPHE 2001 Health Statistics)
Pregnant women not receiving prenatal care as early as they wanted 26.1% vs 19.4% statewide (PRAMS 2000 data)
Source of Most PNC Visit
Hospital Clinic 14.5% Health Dept Clinic 4.3% Private Dr. Office 65.2% Comm. Health (CHC) 7.1% Other 8.9%
Colorado PRAMS data 2000
Financial Sources of Prenatal Care
PNC paid by: (can choose more than one option)Medicaid 26.8%Personal Income 19.2%Insurance 50.7% Military/Tri-Care 19.1%
Colorado PRAMS data 2000
Beginning Transition
Telephone survey to19 OB/GYN offices and all FP offices
13 offices responded representing 29 OB/GYN, 7 FP, 1 nurse midwife
Survey Questions
Weeks into pregnancy accepting new client
Length of time scheduling 1st visit
Accepting Medicaid/PE
Cutoff for accepting prenatal care transfers
Accepting high risk clients
Accepting undocumented immigrants
Types of financial coverage
Involving the Community
Establishing Prenatal Task Force Advisory Group
Goal is to assure a quality system of care for all pregnant women in El Paso County
Key members:Private OB providersMilitary medical personnelBirth centers nurse managersCommunity Health CenterFirst Visitor
Task Force Discussion
Increased military personnel Nursing/paraprofessional staff shortage Potential hospital bed shortage Medicaid reimbursement amount Length of time for Medicaid reimbursement
Task Force Discussion (cont)
Medicaid timeframe for care for women prenatally and postpartum
Lack of use of nurse midwives in the community
Women without prior prenatal care that access ER for pregnancy related concerns
Next Steps
Develop MOU with local Community Health Center
Meetings over several months, looking at safety net role
HD would continue to be a PE/Medicaid site to refer to all Medicaid providers, not just CHC
Community Prenatal Case Manager developed as an assurance role
MOU signed effective 3/02
Community Prenatal Case Manager Role
Works with community providers, including hospitals, CHC and physicians
Networking resources Follow-up with clients on required Medicaid
application paperwork Obtaining referrals from ER on pregnant
women without a provider
Results
Letters sent to providers explaining role, future contact to identify concerns
Contacts made to community agencies serving low-income pregnant women
PE site gave list of OB providers accepting Medicaid, business card of CPCM and told client to call if problems accessing care
Results
OB providers continue to identify concerns such as Medicaid time frames, CPCM able to follow-up on status with Medicaid office, extend PE if necessary
HD survey asking length of time it took to make appointment and see OB provider for 1st time
CPCM able to contact specific provider and identify barriers
Local city owned hospital began same service for pregnant clients in ER with no provider
Individuals served: approx 100 through CPCM and hospital
Public Health Implications
Community Involvement:Gives our organization a better understanding of community issues related to prenatal care for low-income women
Fosters better communication with community OB/Family Practice Medicaid Providers
Public Health Implications
Population-based focus:
Coalition building activity to promote and develop alliances among constituencies for a common purpose
Builds linkages, solves problems and enhances local leadership to address
health concerns
Public Health Implications
Assurance role:Meets several essential public health services including:
Monitoring health status to identify community health problems
Linking people to needed personal health services
Lessons Learned
Agency staff turnover, focus was on individual clients, not community providers. Lost important piece of role
Communication, communication, communication
Community involvement is needed for success
Ongoing evaluation critical HD looking at replicating model with
another at risk population
El Paso County Department of Health and Environment301 South Union Blvd.Colorado Springs, Colorado 80910719-578-3257
Contact Us
Credits
Thanks to the Colorado Springs Convention and Visitors Bureau
and El Paso County Parks Department for the photos of our county.