Perinatal Care in the Community Elizabeth Betty Jordan DNSc, RNC Assistant Professor Johns Hopkins School of Nursing
INTRODUCTION 2
INTRODUCTION Maryland s s preterm birth rate :11.4%/Baltimore City : 14.4% Maryland s s LBW : 9.4%/ Baltimore City s s LBW : 13.4% Maryland s s Cesarean birth rate=31.1% (AA=35.6%) 5.2% of births are to women receiving late or no prenatal care in Baltimore City care in Baltimore City Of the 1,435 babies born in an average week in Maryland 139 are born to teen mothers, 191 are born preterm, 134 are born LBW, & 14 will die before their 1 st birthday. Rank 35 th in U.S. Maryland Vital Statistics' Report (2007). Retrieved July, 2008 3
Objectives: Areas of Study RESEARCH Examine neonatal outcomes of high risk women who received prenatal nurse case management. FACULTY PRACTICE Define the role of the Fetal Infant Mortality review team in the community and examine strategies that contribute to improved maternal and neonatal outcomes. 4
COMMUNITY PARTNERSHIP Describe the Birth Companions program and the maternal and neonatal outcomes of the women served. 5
RESEARCH : Predictors of Neonatal Outcomes Aim : To specifically examine nurse directed prenatal care case management, prenatal care costs and other study variables to determine the impact on neonatal outcomes. 6
RESEARCH : Predictors of Neonatal Outcomes Non-experimental descriptive study Retrospective analysis of medical records linked with patient billing information of patients enrolled in a maternity managed care organization (40 hospitals) Maryland birth certificate data were linked to this study s s data base. Final sample= 825 medical records 7
RESEARCH : Predictors of Neonatal Outcomes Findings Non-case managed women were 3.67 (1.41-9.49) more likely to have VLBW infants Number of visits (0-8), second trimester of care, smoking associated with poorer neonatal outcomes 8
FACULTY PRACTICE : Fetal Infant Mortality Review A community commitment to improved pregnancy outcomes -community-based, -aims to improve pregnancy outcomes, -commitment of community resources Brings hospital & community team members together GOAL: Improved health & well-being of families in Maryland. 9
FACULTY PRACTICE : Fetal Infant Mortality Review Evidenced-based Public Health Approach: Surveillance-monitor sentinel events to identify system failures Quality Assurance-investigate events to develop strategies A national evaluation of FIMR identifies successes & best practices at local level Analyze trends 10
FACULTY PRACTICE : Fetal Infant Mortality Review Case Review Team: All aspects of the medical record Maternal interview Information is de-identified ;trends noted Community Action: : report to health commissioner Ex. of strategies: letters, pamphlet in ER, safe sleep, FM magnets, resource cards 11
FACULTY PRACTICE : Fetal Infant Mortality Review OUTCOMES The examination of performance of essential MCH services by a systems initiative improves care services, education and pregnancy outcomes. Provides insights about activities to improve the health of the population that are not easily measured. 12
COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program Educated 580 nursing students as doulas -90% baccalaureate & 10% master s (CNM/CNS) -Attended 630 births in Baltimore &surrounding area 13
COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program Birth Companions assists underserved or underinsured pregnant women to optimize prenatal care, using community resources to improve maternal and newborn outcomes. Trains nursing students as doulas Offered as an two-credit elective Students learn the community 14
COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program GOALS: -to promote the birth of health newborns in Baltimore -to advocate for & support women in reducing medical interventions -to improve prenatal education & reduce health disparities for underserved families 15
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Neonatal Health Indicators for Birth Companions compared to City, State, and National Norms Neonatal Health indicator Preterm birth of < 37weeks (%) Low birth weight 2500 g or < (%) BC Program 2007-2006 Baltimore City (2006) Maryland (2006) U.S.A (2006) 4.2 14.4 11.3 12.8 3.2 13.4 9.4 8.3 17
Baltimore City Community research faculty practice Community partnership SON faculty with students PhD, DNP, Master s Master s DNP Bacc., Master s (CNS/CNM) Improved perinatal outcomes 18
Thank you! bjordan@son.jhmi.edu 19