Focus on Pediatrics-Database identifies high-risk pregnancies
October 1, 1999 3 minutes read
Focus on Pediatrics-Database identifies high-risk pregnancies
Interventions help improve outcomes
"Healthier Babies," the name of a collaborative Medicaid project in Philadelphia, says it all. That's the purpose and goal of this comprehensive clinical database system that helps identify and track the health behaviors of the pregnant Medicaid women in a five-county region of southeastern Pennsylvania.
The four managed care companies in the region that are participating in this project have access to the data for their members. This access means health plans can try to affect birth outcomes with educational interventions such as smoking cessation programs or nutritional counseling.
"We use the data from Healthier Babies to find out in real time what is going on with each of our pregnant members rather than finding out after the delivery," says Deneen Vojta, MD, chief medical officer for Health Partners, the Philadelphia-based not-for-profit HMO that developed Health ier Babies. A risk assessment tool created by Health Partners helps the company use the database daily to identify women in certain risk categories that the HMO wants to target with educational interventions.
The women who are identified as high-risk are referred to a lay home visitors program for education, which uses trained, culturally sensitive educators to teach women in their homes. For example, if a woman is identified as having a history of pre-term deliveries, she would fall into the high-risk category. She has double the chance of having a pre-term delivery.
The trained lay visitor visits the woman in her home and educates her about pre-term labor. The education includes the signs and symptoms of pre-term labor and what to do if signs should occur.
Other red flags for intervention might be drug and/or alcohol use, smoking, and medical conditions such as diabetes or HIV/AIDS.
When a Medicaid patient comes to a physician's office for prenatal care, the provider fills out an evaluation form and submits it to Healthier Babies so the information can be entered into the database. A follow-up form is filled out at each subsequent visit. Use of the forms was implemented in May 1998.
If the woman changes plans and goes to another provider, the process begins again because the collection system is confidential. Only insurance companies have access to the data, and they are only allowed to see information about their members.
Currently, the database allows HMOs to identify women at risk for low-birth-weight babies and then make sure they get the services they need. In the future, as more data are collected, the database should provide enough information to allow providers to determine which intervention programs make a difference.
"What this means for patient education is that we can be a little more sophisticated in the way we deliver educational interventions to patients who might need them," says Richard J. Baron, MD, president and CEO of Healthier Babies, Inc.
Putting the data to good use
Health Partners currently is in the middle of a project analyzing outcomes related to its use of Healthier Babies data. "I think what is most interesting about this analysis is that we are looking at why people have refused education," says Vojta. The analysis has so far identified the following four main reasons that patients refuse to allow a lay educator to come to the their home to teach:
• I have other children and I know this information.
• I don't want to let strangers into my house.
• I am afraid child protective services will take my other children.
• I don't need education; what I need is a ride.
"Using this analysis, we are trying to come up with more culturally acceptable interventions," says Vojta. Some of the solutions being considered are using community centers for the lay educator's visits, trying to offer education in another way such as the physician's office, and providing transportation.
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