1. AMCHP 2005 Conference PPOR – Another Opportunity for Local / State Capacity Building The Ohio Story Part I Carolyn Slack – Columbus Health Department

2. PPOR comes to the heartland CHD part of National Practice Collaborative Early lessons learned and shared –Data access, availability and quality –PPOR shaping local policy and practice –Sharing information with State partners

3. CHD – What we learned Racial disparities in outcomes Two major area of excess deaths for African American mothers –Prematurity / Womens Health. Statistically significant risk factors – Inadequate PNC and maternal smoking –Infant Health (especially SIDS). Statistically significant risk factors – Inadequate PNC, alcohol use and maternal smoking

4. From Knowing to Doing Focus on addressing Prenatal Care Community collaborative took leadership Lead to additional data gathering Lead to Community action State Health Department working with the community effort and using our data and information for advocacy for State budget dollars

5. Prenatal Care Capacity Prenatal Care is KEY for improving outcomes of pregnancy and the health of women and infants Prenatal Care is often the entry / re- entry into the health care system for women Prenatal Care access, utilization and capacity is a CHALLENGE

6. What do the data tell us? 2002 Data for Ohio and Franklin County % Entering Prenatal Care in the 1st Trimester by Race/Ethnicity Race/Eth.Ohio Franklin Co. White89.4%90.9% Black78.8%78.8% Hispanic80.5%78.0%

7. What do the data tell us? 2002 Data for Ohio and Franklin County % Women with No or Unknown Prenatal Care By Race / Ethnicity Race/Eth.Ohio Franklin Co. White1.5% 6.0% Black5.1%12.0% Hispanic2.9% 7.4%

8. What do the data tell us? Columbus Health Department Perinatal Periods of Risk Analyses: Inadequate Prenatal Care is a statistically significant risk factor for Very Low Birth Weight births for black moms Very Low Birth Weight and Preterm Births are a significant cause of Infant Death

9. Black:White gap largest in 1999 and 2002. Franklin County Infant Mortality 1979-2002* Rate by Race *2002 data are preliminary

10. What do the data tell us? August 2004 Wait Time Survey Summary Average wait time for Initial Prenatal Care Appointment in Franklin County: 24 days Range of wait times for Initial Prenatal Care Appointment: 9-59 days In each survey, 2-4 providers are not even scheduling appointments

11. Goal: Wait time for 1 st OB appointment will be 14 days by 2006. Goal: Wait time for 1 st OB appointment will be 7 days by 2010. What do the data tell us?

12. Council on Healthy Mothers and Babies Prenatal Care Capacity Study Results Initial OB appointments capacity in Franklin County Study done through PCC Provider work group Providers – hospital OB outpatient clinics; neighborhood health center sites; CHD clinic sites 31% DECREASE in Initial OB appointments!

13. Why has capacity decreased? 1.Columbus Health Department – loss of CFHS funding (27% decrease over the last 5 years) and decreased Medicaid revenue (serve women not eligible) resulting in closing a site (FY04) and reducing provider hours (FY 05) 2.Neighborhood Health Centers – loss of funding resulting in clinic consolidations and reduced PNC sessions 3.Hospitals – new rules requiring a reduction in work hours for residents and many now not choosing to allot limited hours to OB

14. What else is affecting capacity? All sites serving more non-English speaking This results in a need for interpreters which is an increased cost, with no reimbursement; and, appointments take longer, thus reducing capacity due to fewer patients can be scheduled Obstetric Malpractice and Liability Issues This issue is resulting in current practitioners leaving OB and fewer medical students choosing OB for their Residency

15. What has happened? The Council has work groups focusing on strategies – including joining with others to work on a Family Planning Waiver The Mayor has included funds in the 2005 City budget to expand PNC The Health Centers have obtained funding for expanding hours at two of their sites. We have had front page coverage in October and January on issues related to PNC and Infant Mortality We have gotten grant funds from ODH to provide a Womens Health Clinic – which will help us provide Interconceptual Care