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Oregon Smoke Free Mothers and Babies Project. Lesa Dixon-Gray, MSW, MPH Office of Family Health (503) 731-8606. Oregon is working towards improving the health of pregnant women and their babies. Smoke Free Mothers and Babies Project. A collaborative partnership including:

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slide1

Oregon Smoke Free Mothers and Babies Project

Lesa Dixon-Gray, MSW, MPH

Office of Family Health

(503) 731-8606

smoke free mothers and babies project
Smoke Free Mothers and Babies Project
  • A collaborative partnership including:
    • Public Health Maternal and Child Health Nurses/Maternity Case Managers
    • Prenatal Care Providers (OB-Gyns, CNMs, Family Practice Physicians)
    • Oregon Quit Line
what is our system for delivering the 5 a s
What is our System for Delivering the “5 A’s”?

Prenatal Care Providers

Maternity Case Management

Oregon Quit Line

who are maternity case managers
Who are Maternity Case Managers?

MCM’s are public health nurses, social workers, and other professionals trained to address the non-medical needs of pregnant clients who have risk factors that often contribute to poor pregnancy outcomes. Their goal – healthy outcomes for families.

prenatal care providers
Prenatal Care Providers
  • 160 OB-GYNs, CNMs, Family Practice Providers in 10 Counties, Comparison and Intervention Groups.
  • Comparison Group becomes Intervention Group over time.
  • Participating PNC providers receive “5A’s” training, fax information from MCMs and the Quit Line, materials and cessation info from SFMB.
oregon s quitline system
Oregon’s Quitline System
  • Public/Private Partnership
  • Available for free for ANY Oregonian
  • Coordinated effort to encourage Statewide use:
    • DHS Tobacco Prevention and Education Program
    • DHS State Medicaid Office and MCO Partners
    • Tobacco Free Coalition of Oregon
  • Fax Referral Procedure – Currently used in several Program Evaluations and Clinical Trials
slide11

What is Smoke Free Mothers and Babies Project?

  • Focus on system change
  • Behavior change of MCMs and PNCPs
  • MCMs and PNCPs use all the "5A's"
  • Intervention is focused on low-income pregnant women via MCM system and Medicaid
  • Collaborative approach between State MCH, State Tobacco Program, State Medicaid Program, Local Public Health Departments, Private Providers, Managed Care, MOD, and ACS
slide12

What do we want to do?

This intervention is designed to increase the use of the “5A’s” by the Oregon Maternity Case Management providers and Prenatal Care Providers (PNCPs), i.e. OB-GYNs, CNMs

project strategies and activities
Project Strategies and Activities
  • Provide Leadership at the State and Local levels
  • Provide Strategies for Improvement to MCMs and Providers
  • Build Community Linkages and Partnerships with Community Organizations
  • Encourage Continuity of Care
  • Provide a Registry at the State and Local levels
  • Provide feedback mechanisms to MCMs and Providers for quality improvement
slide14

Our intervention: How do we do it? An Example…

OFH activity

Site activity

MCM/PNCP outcomes

Train at least

one MCM per site

  • Increased use of 5A’s
  • Increased referrals to QL
  • Increased coordination of
  • activities with PNCPs.

Client outcomes

  • Increased smoking
  • cessation rates
  • Increased rates of
  • successful referrals
  • to QL

MCM train MCM

Train at least one

PNCP recruited

by MCM

  • Increased use of 5A’s
  • Increased referrals to QL
  • Increased coordination of
  • activities with MCMs.

Train PNCP staff

PNCP staff train

their PNCP

how do we do it
How do we do it?
  • Phase 1: Intervention group of MCMs

Intervention group of PNCPs

Comparison group of PNCPs

  • Phase 2: Same intervention group of MCMs

Expanded intervention group of PNCPs

Smaller comparison group of PNCPs

  • Phase 3: Intervention expanded to all PNCPs
how do we collect the data
How do we collect the data?

About the "5A's"

  • From the client: (via MCM)

FAIR form (5 As at MCM visit)

PNCP FAIR form (5 As done by PNCP)

  • From the client (directly from client):

Postpartum survey

how do we collect the data17
How do we collect the data?

About the "5A's"

  • From the MCMs:

3 Surveys (baseline, 12-month follow up, 24-month follow up)

  • From the PNCPs: intervention and comparison

3 Surveys (baseline, 12-month follow up, 24-month follow up)

  • From the Quit Line:

Fax Referral Forms (ongoing basis)

barriers to the process
Barriers to the Process
  • Severe State and Local Funding Cuts
  • Loss of State Tobacco Program
  • Quit Line loss
  • Provider contact
  • Data collection
  • “Buy-in” among disseminated MCMs
lessons learned
Lessons Learned
  • Public Health and Private MD Practice operate in different systems. Public Health needs to learn their lifestyle.
  • Persistence!
  • Need for Collaborative Partners
  • Documentation issues
recommendations
Recommendations
  • A Case Management System as a vehicle to incorporate and provide the “5A’s”
  • A three prong approach for dissemination; one system doesn’t have total responsibility for an intervention
  • Support to Primary Provider System is a necessity in dissemination and implementation of the “5A’s”.
  • The Public Health system needs greater focus on developing strong links with private providers.