1. Peer Physician Maternal Child Health Case Management: The Benefits and Challenges in the Patient-Centered Medical Home
Abigail Love MD MPH, Reena Paul MD,
Nora Smith MD
Cook County-Loyola-Provident FMRP
April 26, 2010

2. Our Practice 5 urban CHCs
>50 FM providers: attend/residents in Maternal Child Health (MCH)
University affiliated
Publicly funded system: “the County”
Budget cuts: lack of staff for QI
Higher risk patients: medically and socioeconomically

3. The QA process
Inconsistent audit process: we have no tracking mechanism, our deliveries our dropping
MCH is a key focus for our dept and QA focus for upcoming year
Pilot site: Jorge Prieto FMHC
3 MD, 1 CNM 4 hour session/month
Average of 16 new OB cases and 20 case follow-ups per month. 
Case-based peer-review using a standardized form in paper chart
Electronic main database: demographics, risk stratification and f/u

4. Why the peer-review model?
Collaborative risk stratification
Evaluating the whole system of care in real-time
Academic/curricular issues
Rich discussion: possible “Faculty development” in MCH care
Qualitative: complex issues that can’t crunched into numerical data

5. Mock Case Demo

6. Preliminary Data: 7 months
119 new OB intakes
58% retention rate of continued pregnancies
Documented follow-up (active, abortion, transfers) in > 90% of cases
Hard to find comparative retention rates: in PNC studies: 4-41%

7. Initial risk of all patients
Risk Stratification
Initial risk of all patients
(n=81)
Initial risk of retained patients
(n= 57)

8. Systems Issues
Volume not retention: We need to get more patients in the door!
Appt access
Pregnancy testing
Shifting demographics
No group visits
Retention issues:
Follow-up appointments: “advanced access”; resident schedules change
Inconsistent approach to no-shows
Lacking provider continuity

9. Provider Issues Common gaps in provision of prenatal care
Screening and follow up of psychosocial issues e.g. IPV and MDD
Medical issues eg varicella screen
Adherence to policies of consultation

10. Summary of Model Drawbacks Benefits
Time burden for physicians and midwife
Training: approach and knowledge base of reviewers
Requires significant nursing and clerical support
Identifies systemic issues affecting patient recruitment, retention and safety
Determines educational needs for resident and faculty development
Identified and triaged several high-risk cases
Gives us data! This is how we justify our jobs!

11. Moving forward Disseminate to all 5 centers Incorporate residents?
Maintain practicing faculty and update “non-MCH” FM faculty

12. Questions to YOU! Resources? Other models?
Risk stratification guideline
Audit forms
Contacts
Other models?

13. Thank you
Janice Benson MD, Associate Chair, Department of Family Medicine, Provident Hospital of Cook County
Crystal Cash MD, Chair, Department of Family Medicine, Provident Hospital of Cook County, System-wide Bureau Chief of Family Medicine, Cook County Health and Hospital Services
Mark Loafman MD