1. Perinatal Care in the Community Elizabeth “Betty” Jordan DNSc, RNC Assistant Professor Johns Hopkins School of Nursing Perinatal Care in the Community Elizabeth “Betty” Jordan DNSc, RNC Assistant Professor Johns Hopkins School of Nursing

2. 2 Perinatal Care in the Community INTRODUCTION INTRODUCTION

3. 3 Perinatal Care in the Community INTRODUCTION INTRODUCTION Maryland’s preterm birth rate :11.4%/Baltimore City : 14.4% Maryland’s preterm birth rate :11.4%/Baltimore City : 14.4% Maryland’s LBW : 9.4%/ Baltimore City’s LBW : 13.4% Maryland’s LBW : 9.4%/ Baltimore City’s LBW : 13.4% Maryland’s Cesarean birth rate=31.1% (AA=35.6%) Maryland’s Cesarean birth rate=31.1% (AA=35.6%) 5.2% of births are to women receiving late or no prenatal 5.2% of births are to women receiving late or no prenatal care in Baltimore City care in Baltimore City Of the 1,435 babies born in an average week in Maryland 139 are born to teen mothers, 191 are born preterm, 134 are born LBW, & 14 will die before their 1 st birthday. Rank 35 th in U.S. Rank 35 th in U.S. Maryland Vital Statistics' Report (2007). Retrieved July, 2008 Maryland Vital Statistics' Report (2007). Retrieved July, 2008

4. 4 Perinatal Care in the Community Objectives: Areas of Study RESEARCH RESEARCH Examine neonatal outcomes of high risk women who received prenatal nurse case management. Examine neonatal outcomes of high risk women who received prenatal nurse case management. FACULTY PRACTICE Define the role of the Fetal Infant Mortality review team in the community and examine strategies that contribute to improved maternal and neonatal outcomes. Define the role of the Fetal Infant Mortality review team in the community and examine strategies that contribute to improved maternal and neonatal outcomes.

5. 5 Perinatal Care in the Community COMMUNITY PARTNERSHIP COMMUNITY PARTNERSHIP Describe the Birth Companions program and the maternal and neonatal outcomes of the women served. Describe the Birth Companions program and the maternal and neonatal outcomes of the women served.

6. 6 Perinatal Care in the Community RESEARCH : Predictors of Neonatal Outcomes RESEARCH : Predictors of Neonatal Outcomes Aim : To specifically examine nurse directed prenatal care case management, prenatal care costs and other study variables to determine the impact on neonatal outcomes.

7. 7 Perinatal Care in the Community RESEARCH : Predictors of Neonatal Outcomes RESEARCH : Predictors of Neonatal Outcomes Non-experimental descriptive study Non-experimental descriptive study Retrospective analysis of medical records linked with patient billing information of patients enrolled in a maternity managed care organization Retrospective analysis of medical records linked with patient billing information of patients enrolled in a maternity managed care organization (40 hospitals) (40 hospitals) Maryland birth certificate data were linked to this study’s data base. Maryland birth certificate data were linked to this study’s data base. Final sample= 825 medical records Final sample= 825 medical records

8. 8 Perinatal Care in the Community RESEARCH : Predictors of Neonatal Outcomes RESEARCH : Predictors of Neonatal Outcomes Findings Findings Non-case managed women were 3.67 (1.41-9.49) more likely to have VLBW infants Non-case managed women were 3.67 (1.41-9.49) more likely to have VLBW infants Number of visits (0-8), second trimester of care, smoking associated with poorer neonatal outcomes Number of visits (0-8), second trimester of care, smoking associated with poorer neonatal outcomes

9. 9 Perinatal Care in the Community FACULTY PRACTICE : Fetal Infant Mortality Review FACULTY PRACTICE : Fetal Infant Mortality Review A community commitment to improved pregnancy outcomes A community commitment to improved pregnancy outcomes-community-based, -aims to improve pregnancy outcomes, -aims to improve pregnancy outcomes, -commitment of community resources -commitment of community resources Brings hospital & community team members together GOAL: Improved health & well-being of families in Maryland.

10. 10 Perinatal Care in the Community FACULTY PRACTICE : Fetal Infant Mortality Review FACULTY PRACTICE : Fetal Infant Mortality Review Evidenced-based Public Health Approach: Surveillance-monitor sentinel events to identify system failures Quality Assurance-investigate events to develop strategies A national evaluation of FIMR identifies successes & best practices at local level Analyze trends

11. 11 Perinatal Care in the Community FACULTY PRACTICE : Fetal Infant Mortality Review FACULTY PRACTICE : Fetal Infant Mortality Review Case Review Team: All aspects of the medical record Maternal interview Information is de-identified ;trends noted Community Action: report to health commissioner Ex. of strategies: letters, pamphlet in ER, safe sleep, FM magnets, resource cards

12. 12 Perinatal Care in the Community FACULTY PRACTICE : Fetal Infant Mortality Review OUTCOMES The examination of performance of essential MCH services by a systems initiative improves care services, education and pregnancy outcomes. The examination of performance of essential MCH services by a systems initiative improves care services, education and pregnancy outcomes. Provides insights about activities to improve the health of the population that are not easily Provides insights about activities to improve the health of the population that are not easily measured. measured.

13. 13 Perinatal Care in the Community COMMUNITY PARTNERSHIP: COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program Educated 580 nursing students as “doulas” -90% baccalaureate & 10% master’s (CNM/CNS) -Attended 630 births in Baltimore &surrounding area

14. 14 Perinatal Care in the Community COMMUNITY PARTNERSHIP: COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program Birth Companions assists underserved or underinsured pregnant women to optimize prenatal care, using community resources to improve maternal and newborn outcomes. Trains nursing students as “doulas” Trains nursing students as “doulas” Offered as an two-credit elective Offered as an two-credit elective Students learn the community Students learn the community

15. 15 Perinatal Care in the Community COMMUNITY PARTNERSHIP: COMMUNITY PARTNERSHIP: JHUSON Birth Companions Program GOALS: -to promote the birth of health newborns in Baltimore -to advocate for & support women in reducing medical interventions -to improve prenatal education & reduce health disparities for underserved families

16. 16 Perinatal Care in the Community

17. 17 Perinatal Care in the Community Neonatal Health Indicators for Birth Companions compared to City, State, and National Norms Neonatal Health Indicators for Birth Companions compared to City, State, and National Norms Neonatal Health indicator BC Program 2007-2006 Baltimore City (2006) Maryland (2006) U.S.A (2006) Preterm birth of < 37weeks (%) 4.2 14.411.312.8 Low birth weight 2500 g or < (%) 3.2 13.49.48.3

18. 18 Perinatal Care in the Community Baltimore City Community research faculty practice Community partnership SON faculty with students PhD, DNP, Master’s Master’s DNP Bacc., Master’s (CNS/CNM) Improved perinatal outcomes

19. 19 Perinatal Care in the Community Thank you! bjordan@son.jhmi.edu