Education holds the key to better perinatal outcomes
February 1, 1997 4 minutes read
Education holds the key to better perinatal outcomes
Program yields 8% drop in premature births
The formula is simple. Assess perinatal risk factors early in pregnancy; provide 24-hour access to education and information; and provide case management and obstetrical home care services, when necessary.
The results are promising. The managed care organization (MCO) experiences an 8% drop in the preterm births in 1994 and a 7.2% drop in 1995 in its general insured population. The MCO also experiences a drop in its cesarean rate from 26% in 1992 to 20% in 1995.
Better still, ChoiceCare of Greater Cincinnati, a 282,000-member health plan, reduced perinatal costs for its 12,500-member Medicaid population by 50%, from $15,235 per member in 1992 to $7,432 between June 1994 and May 1995. And the preterm delivery rate in the Medicaid population dropped from 9% in 1994 to 8.5% in 1995. "We launched ChoiceWise Perinatal Program for our general insured population shortly after developing ChoiceWise Special Health for our Medicaid population," notes Gil Blackburn, MD, FACOG, medical director of OB/GYN for ChoiceCare.
"The Medicaid population had a preterm delivery rate of 15% in 1992. The health risks and high costs associated with that preterm rate prompted us to start an aggressive management process to try to reduce the number of preterm deliveries in our Medicaid population," he says. ChoiceCare contracted with Matria Healthcare in Marietta, GA, to deliver the two perinatal programs, explains Blackburn, adding that ChoiceCare recently transferred its Medicaid population to another health plan.
Creating self-esteem
ChoiceCare ran the ChoiceCare Special Health program for three years. The program began with a comprehensive in-home assessment of the mother and her environment by a perinatal nurse. "The initial interview took as long as three hours and the nurse reviewed in detail issues such as proper nutrition, the importance of prenatal appointments, and the risks and warnings signs of premature labor," says Blackburn. Nurses also provided each mother with reading materials written on a sixth-grade level. Results of the in-home assessment were mailed to the patient's physician.
The Medicaid population often faces additional risk factors due to socioeconomic disadvantages, notes Blackburn. During the in-home assessment, nurses looked at a variety of socioeconomic risk factors including:
• the patient's support system;
• the presence of the baby's father;
• the educational level of the mother;
• the presence of other children in the household.
"The same nurse would call these patients a minimum of once a month to check on their progress and make sure they were keeping their prenatal appointments. They became in essence surrogate parents for these women in a way," he notes. "I believe it helped these women establish a greater degree of self-esteem to know that they were not alone, and that someone cared about their health," he adds. "A greater number of women kept their prenatal appointments because they knew that someone would call to check that the appointment was kept."
ChoiceWise Special Health also offered a series of two perinatal education classes. "We felt that we would have greater compliance if we had only two education sessions. The first class focused on early changes in pregnancy, risk factors, and nutrition. The second class focused on labor and delivery, well-baby care, mothering, and birth control," Blackburn notes.
The health plan boosted attendance at its educational sessions by eliminating common obstacles and providing incentives, he says. "We went into the local community and found convenient locations for our classes. We also provided food, transportation and babysitting services to encourage women to attend."
The program also included a postpartum home health visit. "Much of the focus of the postpartum visit was on birth control. Nurses stressed that mothers would have better outcomes for this baby and the next, if they avoided having another pregnancy in close proximity."
Less intense, same results
The ChoiceWise Perinatal Program has been as successful in reducing preterm births and cesarean rates in the plan's general insured, or commercial, population as ChoiceWise Special Health was in improving outcomes for its Medicaid population, notes Blackburn. Physicians notify ChoiceCare about the pregnancy after the patient's first prenatal visit. A perinatal nurse conducts a telephonic risk assessment with the mother and mails the results back to the obstetrician. "Members are also given a 24-hour toll-free number to access education and information from perinatal nurses," notes Blackburn. Plan members also receive magazines designed to arrive at different stages of pregnancy. "The magazines are to augment literature members get from their doctors. The entire program is to enhance the high- quality care members receive from our physicians," says Blackburn, adding that in his opinion the success of both programs is due to their focus on signs and symptoms of preterm labor.
"Because of the perinatal programs, our members know that if they have cramping at 26 weeks, they must come in and get evaluated. Our physicians have collaborated with us to make reducing preterm delivery a priority. They make an effort to get these women in the office in a timely manner and see if there are any cervical changes. By focusing on this issue, we have been very effective in reducing preterm births," he notes.
(For case studies of other perinatal disease management programs, see Case Management Advisor, May 1996, pp. 57-61, and June 1996, pp. 80-82.)
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