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Community Prenatal Case Manager: Linking pregnant women to prenatal care

Community Prenatal Case Manager: Linking pregnant women to prenatal care. MaryJo Rosazza, RNC, MS Perinatal Health Program Director El Paso County Department of Health and Environment Colorado Springs, Colorado. El Paso County Demographics. Population 541,495 8557 births

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Community Prenatal Case Manager: Linking pregnant women to prenatal care

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  1. Community Prenatal Case Manager: Linking pregnant women to prenatal care MaryJo Rosazza, RNC, MS Perinatal Health Program Director El Paso County Department of Health and Environment Colorado Springs, Colorado

  2. El Paso County Demographics • Population 541,495 • 8557 births • 25% births paid by Medicaid • LBW rate 9.6% • Pre-maturity rate 9.4% 2002 CDPHE Health Statistics 2000 PRAMS data

  3. El Paso County Demographics

  4. Background • Safety net role of HD Women’s Clinic • Community Health Center transition to traditional model

  5. Concerns • Prenatal care 1st Trimester 79.6% • No prenatal care 1.2% (CDPHE 2001 Health Statistics) • Pregnant women not receiving prenatal care as early as they wanted 26.1% vs 19.4% statewide (PRAMS 2000 data)

  6. Source of Most PNC Visit • Hospital Clinic 14.5% • Health Dept Clinic 4.3% • Private Dr. Office 65.2% • Comm. Health (CHC) 7.1% • Other 8.9% Colorado PRAMS data 2000

  7. Financial Sources of Prenatal Care • PNC paid by: (can choose more than one option) Medicaid 26.8% Personal Income 19.2% Insurance 50.7% Military/Tri-Care 19.1% Colorado PRAMS data 2000

  8. Beginning Transition • Telephone survey to19 OB/GYN offices and all FP offices • 13 offices responded representing 29 OB/GYN, 7 FP, 1 nurse midwife

  9. Weeks into pregnancy accepting new client Length of time scheduling 1st visit Accepting Medicaid/PE Cutoff for accepting prenatal care transfers Accepting high risk clients Accepting undocumented immigrants Types of financial coverage Survey Questions

  10. Involving the Community • Establishing Prenatal Task Force Advisory Group • Goal is to assure a quality system of care for all pregnant women in El Paso County • Key members: Private OB providers Military medical personnel Birth centers nurse managers Community Health Center First Visitor

  11. Increased military personnel Nursing/paraprofessional staff shortage Potential hospital bed shortage Medicaid reimbursement amount Length of time for Medicaid reimbursement Task Force Discussion

  12. Medicaid timeframe for care for women prenatally and postpartum Lack of use of nurse midwives in the community Women without prior prenatal care that access ER for pregnancy related concerns Task Force Discussion (cont)

  13. Develop MOU with local Community Health Center Meetings over several months, looking at safety net role HD would continue to be a PE/Medicaid site to refer to all Medicaid providers, not just CHC Community Prenatal Case Manager developed as an assurance role MOU signed effective 3/02 Next Steps

  14. Community Prenatal Case Manager Role • Works with community providers, including hospitals, CHC and physicians • Networking resources • Follow-up with clients on required Medicaid application paperwork • Obtaining referrals from ER on pregnant women without a provider

  15. Results • Letters sent to providers explaining role, future contact to identify concerns • Contacts made to community agencies serving low-income pregnant women • PE site gave list of OB providers accepting Medicaid, business card of CPCM and told client to call if problems accessing care

  16. Results • OB providers continue to identify concerns such as Medicaid time frames, CPCM able to follow-up on status with Medicaid office, extend PE if necessary • HD survey asking length of time it took to make appointment and see OB provider for 1st time • CPCM able to contact specific provider and identify barriers • Local city owned hospital began same service for pregnant clients in ER with no provider • Individuals served: approx 100 through CPCM and hospital

  17. Public Health Implications • Community Involvement: Gives our organization a better understanding of community issues related to prenatal care for low-income women Fosters better communication with community OB/Family Practice Medicaid Providers

  18. Population-based focus: Coalition building activity to promote and develop alliances among constituencies for a common purpose Builds linkages, solves problems and enhances local leadership to address health concerns Public Health Implications

  19. Assurance role: Meets several essential public health services including: Monitoring health status to identify community health problems Linking people to needed personal health services Public Health Implications

  20. Lessons Learned • Agency staff turnover, focus was on individual clients, not community providers. Lost important piece of role • Communication, communication, communication • Community involvement is needed for success • Ongoing evaluation critical • HD looking at replicating model with another at risk population

  21. Contact Us • El Paso County Department of Health and Environment 301 South Union Blvd. Colorado Springs, Colorado 80910 719-578-3257

  22. Credits • Thanks to the Colorado Springs Convention and Visitors Bureau and El Paso County Parks Department for the photos of our county.

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