community prenatal case manager: linking pregnant women to prenatal care

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Community Prenatal Case Manager: Linking pregnant women to prenatal care MaryJo Rosazza, RNC, MS Perinatal Health Program Director El Paso County Department of Health and Environment Colorado Springs, Colorado

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Community Prenatal Case Manager: Linking pregnant women to prenatal care. MaryJo Rosazza, RNC, MS Perinatal Health Program Director El Paso County Department of Health and Environment Colorado Springs, Colorado. El Paso County Demographics. Population 541,495 8557 births - PowerPoint PPT Presentation

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Page 1: 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

Page 2: Community Prenatal Case Manager: Linking pregnant women to prenatal care
Page 3: Community Prenatal Case Manager: Linking pregnant women to prenatal care
Page 4: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 5: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 6: Community Prenatal Case Manager: Linking pregnant women to prenatal care
Page 7: Community Prenatal Case Manager: Linking pregnant women to prenatal care

Background

Safety net role of HD Women’s Clinic

Community Health Center transition to traditional model

Page 8: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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)

Page 9: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 10: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 11: Community Prenatal Case Manager: Linking pregnant women to prenatal care

Beginning Transition

Telephone survey to19 OB/GYN offices and all FP offices

13 offices responded representing 29 OB/GYN, 7 FP, 1 nurse midwife

Page 12: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 13: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 14: Community Prenatal Case Manager: Linking pregnant women to prenatal care

Task Force Discussion

Increased military personnel Nursing/paraprofessional staff shortage Potential hospital bed shortage Medicaid reimbursement amount Length of time for Medicaid reimbursement

Page 15: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 16: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 17: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 18: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 19: Community Prenatal Case Manager: Linking pregnant women to prenatal 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

Page 20: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 21: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

Page 22: Community Prenatal Case Manager: Linking pregnant women to prenatal care

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

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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

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El Paso County Department of Health and Environment301 South Union Blvd.Colorado Springs, Colorado 80910719-578-3257

Contact Us

Page 25: Community Prenatal Case Manager: Linking pregnant women to prenatal care

Credits

Thanks to the Colorado Springs Convention and Visitors Bureau

and El Paso County Parks Department for the photos of our county.

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