The Denver Collaborative to Reduce Alcohol-Exposed

Pregnancy

Kellie Teter, Karen Peterson, Pam Gillen, Grace Alfonsi

& Team

October 2012 PSEP Meeting

Context

• Denver Health and Hospital Authority (Denver Health) is the largest safety net health care system in Colorado, and in fact in Region VIII

• It is an integrated health care system, joining a hospital with neighborhood community health centers

• Denver Public Health (DPH) is a Department of Denver Health

Context, cont.• Through its Community Health Services,

Denver Health provides primary care (medical, dental and mental health) to about 20% of adults and 35% of children residing in Denver County

• Over 3500 deliveries occur yearly at Denver Health

• Despite this integrated system and efforts to streamline services, however, Denver Health and DPH continue to operate within numerous silos

Context, cont.

• No alcohol or contraceptive use data (except anecdotal) from entirety of DH system

• The STD clinic at DPH has data in reproductive age women (2010 – 11)– 34% report binge, 20% heavy, and 19% both

binge and heavy drinking– Therefore, 35% report risky drinking– The risky drinking women have an ineffective

contraception rate of 60%Binge drinking = 4 or more drinks on at least one occasion in the last 90 days Heavy drinking = 8 or more drinks/week during at least one week in the last 90 days

LEAN Process

Identifying Initial Condition

Black box about what happens at this step because no consistent documentation is required

}

Initial Condition

Target Condition

Progress: EMR Questions• DH is adopting a new electronic medical

record (EMR)• Team was able to identify and influence key

participants in the EMR process to ensure alcohol, drug and tobacco screening would be mandatory components of the EMR

• SBIRT questions formed the backbone of these sections

• Contraceptive questions still in progress but will be detailed as the CHS sites are Title X sites

New EMR: Alcohol/Drug Questions

New EMR: Tobacco Questions

Progress: Educational Modules

• Prior to rollout of EMR in 1/13, plan is to educate staff about AEP so that they utilize the new EMR capability well

• Team has been developing 10-minute educational modules to deliver in clinic settings across the DH system

Educational Modules, cont.

• Team educators will negotiate with the clinics about how much time is available and which topics are most important for their staffs

• Goal is to deliver as many modules as possible – as a single presentation– as short presentations spread over time

Module topics

1. How much is too much?

2. Why is too much alcohol bad news?

3. Fetal development and substance use

4. Use vs. Abuse vs. Dependence

5. Techniques to cut down and/or quit alcohol use

6. Youth Health and substance use

7. Marijuana information and side effects

What is one drink? 1/2 Oz. Absolute Alcohol

12 oz. Beer

X 4% alcohol

= .48 oz. AA

4 oz. WineX 12% alcohol= .48 oz. AA

1.2 oz. LiquorX 40% alcohol= .48 oz. AA

Beer Table wine Hard Liquor

Module 1: How much is too much?

Alcohol MetabolismApproximate Blood Alcohol Concentrations (BAC) 130

pound woman (after 1, 2 or 3 drinks in one hour)

1 hour 2 hours 3 hours 4 hours0

0.05

0.1

0.15

0.2

0.25

3 drinks

2 drinks

1 drink

Module 2: Why is too much alcohol bad news?

Timeline of Fetal Development4 5 6 7 8 9 10 11 12 (weeks)

Central Nervous SystemCentral Nervous System

HeartHeart

ArmsArms

EyesEyes

LegsLegs

TeethTeeth

PalatePalate

External genitaliaExternal genitalia

EarEar

Missed Period Mean Entry into Prenatal Care

Module 3: Fetal development and substance use

0 ho

ur

1 ho

ur

1.5

hour

s

2 ho

urs

2.5

hour

s

3 ho

ur0

10

20

30

40

Maternal BAC

Fetal BAC

Mg

%

Diffusion from Mother to Fetus

Diffusion from Fetus back to Mother

Diffusion of Alcohol Across Placenta Following ONE Drink

Module 3: Fetal development and substance use

lifetime abstinence

current abstinence

low risk drinking

hazardous drinking

harmful drinking

dependence symptoms

dependence

25%

71%

4%

Module 5: Use vs. Abuse vs. Dependence

Encourage to continue

current behavior

Brief Intervention

Refer for

Treatment

25%

71%

4%

Module 5: Use vs. Abuse vs. Dependence

Low-risk or no Alcohol Use

Excessive Alcohol Use

Alcohol Dependent

Posters/Presentations

• Denver Health Day of Celebration (5/12)

• Colorado AHEC Conference (9/12)

• APHA Conference (11/12)

• CityMatCH Conference (12/12)