delivering prenatal education through community collaboratives a catalyst for improved maternity...
TRANSCRIPT
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Delivering Prenatal Education through
Community Collaboratives
A Catalyst for Improved Maternity Services and Birth
Outcomes
Diane M. DaldrupState Director Program & Government Affairs
November 19, 2014
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Presenter Conflict of Interest Disclosure
Diane M. Daldrup, State Director of Program and Government Affairs, March of Dimes Greater Kansas Chapter has no relationships to disclose.
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Course Objectives
At the conclusion of this workshop participants will:
● Know the leading issues impacting Kansas birth outcomes
● Learn about the Healthy Babies are Worth the Wait/Becoming A Mom program model
● Understand the community collaborative model and it’s role within the collective impact framework
● Understand the role of evaluation in program quality improvement
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Birth Disparities in Kansas
● Infant Mortality - 6.3/1000 live births● Birth defects, preterm birth/low birth weight, SUID leading
causes● Black infant mortality rate is more than double white
● Preterm Birth Rate – 10.8%● 16.3% African American, 11.5 % Hispanic, 10.2%
Caucasian
● Smoking 21.5% (women of childbearing age)
● Medicaid pays for 45% of all births● Medicaid vs non-Medicaid disparity
● *2012 Data
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Kansas Priorities
● Lower preterm birth rate 8% by 2020 (ASTHO Challenge)●Lower infant mortality rate 10% by 2016 (CoIIN Blueprint)
***************************************
● Improve access and quality of prenatal care services● Launch community collaboratives in high-need areas● Statewide Expansion:
● Healthy Babies are Worth the Wait/Becoming a Mom● Safe Sleep Campaign● High Five for Baby● Tobacco Quit Line
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March of Dimes Response
Strategic Mission Investment
• Targeted communities with demonstrated disparities
• Significant number of births
• Community collaborative backbone
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Community Collaborative Model
• “Collaboration is a mutually beneficial relationship between two or more parties who work toward common goals by sharing responsibility, authority, and accountability for achieving results.“
• (Collaborative Leadership; Chrislip & Larson, 1994)
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Collaborative strategy is called for ... where the need and intent is to change fundamentally the way services are designed and delivered
"Collaboration establishes a give and take among stakeholders that is designed to produce solutions that none of them working independently could achieve.“
(Enhancing Transdisciplinary Research through Collaborative Leadership, Barbara Gray, 2006)
Collaborative Strategy
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CDC Health Promotion Model
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Collaboration Benefits
• Permanent MCH Infrastructure developed
• Resources leveraged for greater benefit
• Care delivery paradigm changed• Long-term program sustainability• Emerging community needs identified
early• Collaborative becomes vehicle for
change• Magnet for new funding opportunitiesShared risk, shared resources, shared rewards!
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Healthy Babies are Worth the Wait
Six Key Strategies● Hospital Quality Improvement● Community Intervention
Programs● Public Policy● Consumer Awareness● Provider Education● Patient Education
Healthy Babies are Worth the Wait is a March of Dimes Signature Program designed to decrease preventable preterm and early term births
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Becoming A Mom - What is it? Bilingual prenatal curriculum
Designed for use with pregnant women in a supportive group setting
Nine sessions Prenatal care Nutrition Stress Things to avoid during pregnancy Labor and birth Postpartum care Newborn care
Appendices with suggestions for adapting the curriculum for use with specific racial/ethnic groups
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Incentive-based programEvidence-based curriculumStandardized deliveryStandardized evaluation system
Becoming A Mom in Kansas
Two-fold focus – Clinical Services + Prenatal Education
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Collective Impact in Action
Growth Strategies● State funds two priority
replications● Eight additional non-funded sites● Regional models in the works● KanCare providers coming on
board● Policy changes
● Presumptive Eligibility● Title V Incentive● CHW Waiver (fee for service $)
● Funding Magnet● KS Health Foundation ($900,000)● New Healthy Start Site ($3.5M)● HRSA Rural Network Grant ($85,000)
Community Collaboratives/Healthy Babies are Worth the Wait launched in eight additional
communities
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Program Evaluation
Collaborative program evaluation led by researchers from two state universities
Data from 2013 was collected from two levels:
• Participant-level (BAM Programso self-reported knowledge (pre/post test)o health outcome data from medical
charts
• Community-level data o self-reported implementation data
through the Community Toolbox online system
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Program Evaluation Core Components
• Universal class structure and delivery
• Standardized evaluation tools
• Data collectors trained at each site• Technical assistance ad hoc
• Bi-annual grantee meeting for quality improvement
• Participation incentivized• 79% of women (n=165) completed 4 or more
classes
• Monthly data submission
• Bi-annual reports to each site
• Bi-annual aggregated reports
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Data Tools: Community-Level
• Community toolbox – ctb.ku.edu• Online tool to assist sites with
documenting collaborative nature of model
• Includes approximately 20 questions related to collaborative actions and program implementation
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Data Tools: Program-LevelBecoming a Mom Evaluation
• First piloted in Kansas in 2012; modified in 2013
• Pre/post knowledge survey (approx. 100 questions)
• Administered at 1st and last prenatal education sessions
• Participation and program satisfaction included
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baby's brain growthand development
Signs of Preterm Labor Safe Sleep Habits
81%
49%
81%
95%
83%
98%
Pre
Post
Participant Level Data
p=.004 p=.0002p<.0001
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Improved Birth Outcomes
• Community health outcomes vs state averages• Fewer preterm births - 9.5% compared to 11% (n=42)• Low birth weight – 4% compared to 7.1% (n=68)• Lower cesarean section rate – 26% versus 30% (n=87)• Higher breastfeeding initiation - 81% versus 80% (n=85)
• Contributed to lower infant mortality rate• Saline - 8.5/1000 (2006-2010) to 6.4/1000 (2008-2012
KDHE)• Geary - 10/1000 (2006-2010) to 8.3/1000 (2008-2012
KDHE)
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Create pilot programs for replication and the stakeholders and money will follow!
Collaborative model works – but requires constant nurturing to keep stakeholders engaged
Community customization increases impact and provides vehicle for identification of emergent issues
Program standardization is essential for evaluation accuracy
Evaluation accuracy will make or break a program – Get your data and evaluation experts on board up front!
Lessons Learned
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thank you