Carmen Strickland, MD, MPH October 28, 2009 Centering Models: Group Care for Improved Perinatal Outcomes.

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Presentation transcript:

Carmen Strickland, MD, MPH October 28, 2009 Centering Models: Group Care for Improved Perinatal Outcomes

Centering Healthcare Institute, Inc CenteringPregnancy CenteringParenting

CenteringPregnancy: Recruitment Initial intake to system as usual (History, physical, lab work) Invite 8-12 women with similar due dates into the group

CenteringPregnancy: Schedule Four sessions every 4 weeks 16, 20, 24, 28 weeks Six sessions every 2 weeks 30, 32, 34, 36, 38, 40 weeks Plan for a reunionBetween 1-2 months postpartum Additional visits as needed to address issues

Design: Two-Hour Session minutes Check-in and individual assessments with the provider minutes Formal “circle-up” or facilitated discussion time Informal time for socializing Closing and follow-up as needed

Centering: a model for group health care EDUCATION ASSESSMENT SUPPORT

CenteringPregnancy- Forsyth County Southside United Health and Wellness Center Governed by community board Funding: Winston-Salem Foundation Kate B Reynolds BC/BS Winston-Salem State School of Health Sciences (in-kind donation of equipment) March of Dimes: Centering Pregnancy Implementation

Program Characteristics Reimbursement: Same as Traditional PNC Demographics: All populations served Services offered:Endless possibilities … Dental Family Planning Nutrition Lactation WIC/Baby Love

National Institute of Mental Health #MH 61175, Ickovics, et al. (2007)Obstetrics & Gynecology. 110(2): Effects of Group Prenatal Care: Randomized Control Trial

Outcomes: Preterm Birth Decreased rate of preterm birth (OR 0.67, 95%CI ) Decreased rate of preterm birth among African American ( OR=.59; 95%CI )

78% average attendance rate for group participants Significantly higher prenatal knowledge and readiness for labor & delivery (each p<.001)* Greater rates of breastfeeding initiation (66.5% v 54.6% p<.001) Significantly greater satisfaction with care (F=27.2, p<.001) No difference antenatal or delivery costs (p>0.69) Secondary Outcomes: 2006 Randomized Control Trial *Planned contrast CP+/CP vs control; measured post-intervention Ickovics, et al. (2007) Obstetrics & Gynecology. 110(2):

CenteringParenting Group well child and first postpartum year care Similar model: shared visit, structured around standard immunization schedule

CenteringParenting Family planning/contraception Preconception health (nutrition/folic acid; exercise/wt.management; substance abuse) Mental health OPPORTUNITY for Interconception care of the new Mom

“ We came at the same time and left at the same time and something happened the whole time we were there. ” - Group Participant “ I am learning that it doesn’t matter what we don’t talk about, because we are talking about what matters to the group. ” “ In truth, I continue to be awed by the power of the group. We are having such a good time and have such laughs. - Claire Westdahl, CNM

CHI 558 Maple Avenue Cheshire, CT