Perinatal Care in the Community Elizabeth “Betty” Jordan DNSc, RNC Assistant Professor Johns Hopkins School of Nursing Perinatal Care in the Community

Perinatal CarePerinatal Carein the Communityin the Community

Elizabeth “Betty” Jordan Elizabeth “Betty” Jordan DNSc, RNCDNSc, RNC

Assistant ProfessorAssistant Professor Johns Hopkins School of Johns Hopkins School of

NursingNursing

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Perinatal Care in the Perinatal Care in the CommunityCommunity

INTRODUCTIONINTRODUCTION

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INTRODUCTIONINTRODUCTION Maryland’s preterm birth rate :11.4%/Baltimore City : 14.4%Maryland’s preterm birth rate :11.4%/Baltimore City : 14.4% Maryland’s LBW : 9.4%/ Baltimore City’s LBW : 13.4%Maryland’s LBW : 9.4%/ Baltimore City’s LBW : 13.4% Maryland’s Cesarean birth rate=31.1% (AA=35.6%)Maryland’s Cesarean birth rate=31.1% (AA=35.6%) 5.2% of births are to women receiving late or no prenatal5.2% of births are to women receiving late or no prenatal

carecare in Baltimore City in Baltimore City

Of the 1,435 babies born in an average week in Maryland 139 are born to 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 teen mothers, 191 are born preterm, 134 are born LBW, & 14 will die before their 1their 1stst birthday. birthday.

Rank 35Rank 35thth in U.S. in U.S.

Maryland Vital Statistics' Report (2007). Retrieved July, 2008 Maryland Vital Statistics' Report (2007). Retrieved July, 2008

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Objectives:Objectives: Areas of Study Areas of Study RESEARCHRESEARCH Examine neonatal outcomes of high risk women who Examine neonatal outcomes of high risk women who

received prenatal nurse case management .received prenatal nurse case management .

FACULTY PRACTICEFACULTY PRACTICE Define the role of the Fetal Infant Mortality review team Define the role of the Fetal Infant Mortality review team

in the community and examine strategies that contribute in the community and examine strategies that contribute to improved maternal and neonatal outcomes. to improved maternal and neonatal outcomes.

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COMMUNITY PARTNERSHIPCOMMUNITY PARTNERSHIP Describe the Birth Companions program Describe the Birth Companions program

and the maternal and neonatal outcomes and the maternal and neonatal outcomes of the women served.of the women served.

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RESEARCH : Predictors of Neonatal RESEARCH : Predictors of Neonatal OutcomesOutcomes

Aim Aim : : To specifically examine nurse directed To specifically examine nurse directed prenatal care case management, prenatal prenatal care case management, prenatal

care care costs and other study variables to determine costs and other study variables to determine

thetheimpact on neonatal outcomesimpact on neonatal outcomes..

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RESEARCH : Predictors of Neonatal OutcomesRESEARCH : Predictors of Neonatal Outcomes

Non-experimental descriptive studyNon-experimental descriptive study Retrospective analysis of medical records linked with Retrospective analysis of medical records linked with

patient billing information of patients enrolled in a patient billing information of patients enrolled in a maternity managed care organizationmaternity managed care organization

(40 hospitals)(40 hospitals) Maryland birth certificate data were linked to this study’s Maryland birth certificate data were linked to this study’s

data base.data base. Final sample= 825 medical recordsFinal sample= 825 medical records

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RESEARCH : Predictors of Neonatal OutcomesRESEARCH : Predictors of Neonatal Outcomes FindingsFindings Non-case managed women were Non-case managed women were 3.67 (1.41-3.67 (1.41-

9.49) 9.49) more likely to have VLBW infantsmore likely to have VLBW infants

Number of visits (0-8), second trimester of Number of visits (0-8), second trimester of care, smoking associated with poorer neonatal care, smoking associated with poorer neonatal outcomes outcomes

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FACULTY PRACTICE : Fetal Infant Mortality ReviewFACULTY PRACTICE : Fetal Infant Mortality Review

A community commitment to improved pregnancy A community commitment to improved pregnancy outcomesoutcomes-community-based, -community-based,

-aims to improve pregnancy outcomes, -aims to improve pregnancy outcomes, -commitment of community resources-commitment of community resourcesBrings hospital & community team members togetherBrings hospital & community team members together

GOAL: Improved health & well-being of families in Maryland.GOAL: Improved health & well-being of families in Maryland.

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FACULTY PRACTICE : Fetal Infant Mortality ReviewFACULTY PRACTICE : Fetal Infant Mortality Review

Evidenced-based Public Health Approach:Evidenced-based Public Health Approach:SurveillanceSurveillance-monitor sentinel events to identify -monitor sentinel events to identify system failuressystem failuresQuality AssuranceQuality Assurance-investigate events to-investigate events todevelop strategiesdevelop strategies

A national evaluation of FIMR identifies successesA national evaluation of FIMR identifies successes& best practices at local level& best practices at local levelAnalyze trendsAnalyze trends

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FACULTY PRACTICE : Fetal Infant Mortality ReviewFACULTY PRACTICE : Fetal Infant Mortality ReviewCase Review TeamCase Review Team::All aspects of the medical recordAll aspects of the medical recordMaternal interviewMaternal interviewInformation is de-identified ;trends notedInformation is de-identified ;trends noted

Community ActionCommunity Action: report to health commissioner: report to health commissionerEx. of strategies: letters, pamphlet in ER, safe sleep,Ex. of strategies: letters, pamphlet in ER, safe sleep,FM magnets, resource cardsFM magnets, resource cards

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FACULTY PRACTICE : Fetal Infant Mortality ReviewFACULTY PRACTICE : Fetal Infant Mortality Review OUTCOMESOUTCOMES The examination of performance of essential MCH The examination of performance of essential MCH

services by a systems initiative improves care services, services by a systems initiative improves care services, education and pregnancy outcomes.education and pregnancy outcomes.

Provides insights about activities to improve the health of Provides insights about activities to improve the health of the population that are not easily the population that are not easily

measured.measured.

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COMMUNITY PARTNERSHIP:COMMUNITY PARTNERSHIP:JHUSON Birth Companions ProgramJHUSON Birth Companions ProgramEEducated 580 nursing students as “doulas”ducated 580 nursing students as “doulas”-90% baccalaureate & 10% master’s -90% baccalaureate & 10% master’s

(CNM/CNS)(CNM/CNS)

-Attended 630 births in Baltimore -Attended 630 births in Baltimore &surrounding area&surrounding area

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COMMUNITY PARTNERSHIP:COMMUNITY PARTNERSHIP:JHUSON Birth Companions ProgramJHUSON Birth Companions Program

Birth Companions assists underserved or Birth Companions assists underserved or underinsured pregnant women to optimize prenatal underinsured pregnant women to optimize prenatal care, using community resources to improve maternal care, using community resources to improve maternal and newborn outcomes.and newborn outcomes.

Trains nursing students as “doulas”Trains nursing students as “doulas” Offered as an two-credit electiveOffered as an two-credit elective Students learn the communityStudents learn the community

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COMMUNITY PARTNERSHIP:COMMUNITY PARTNERSHIP:JHUSON Birth Companions ProgramJHUSON Birth Companions ProgramGOALS:GOALS:--to promote the birth of health newborns in to promote the birth of health newborns in

BaltimoreBaltimore-to advocate for & support women in reducing -to advocate for & support women in reducing

medical interventionsmedical interventions-to improve prenatal education & reduce health -to improve prenatal education & reduce health disparities for underserved familiesdisparities for underserved families

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Neonatal Health Indicators for Birth Neonatal Health Indicators for Birth Companions compared to City, State, Companions compared to City, State, and National Norms and National Norms

Neonatal Health indicator

BC Program2007-2006

Baltimore City (2006)

Maryland(2006)

U.S.A(2006)

Preterm birth of < 37weeks (%)

4.2 14.4 11.3 12.8

Low birth weight 2500 g or <(%)

3.2 13.4 9.4 8.3

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Baltimore City Community

research faculty practice

Community partnership

SON faculty with students

PhD, DNP, Master’s

Master’sDNP

Bacc.,Master’s (CNS/CNM)

Improved perinatal outcomes

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Thank you! [email protected]

Documents

Perinatal Care in the Community Elizabeth “Betty” Jordan DNSc, RNC Assistant Professor Johns Hopkins School of Nursing Perinatal Care in the Community