PPOR – Another Opportunity for Local / State Capacity Building The Ohio Story Part I Carolyn Slack – Columbus Health Department
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
CHD – What we learned • Racial disparities in outcomes • Two major area of excess deaths for African American mothers • Prematurity / Women’s 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
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
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
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.OhioFranklin Co. White 89.4% 90.9% Black 78.8% 78.8% Hispanic 80.5% 78.0%
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.OhioFranklin Co. White 1.5% 6.0% Black 5.1% 12.0% Hispanic 2.9% 7.4%
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
Franklin County Infant Mortality1979-2002* Rate by Race Black:White gap largest in 1999 and 2002. *2002 data are preliminary
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 providersare not even scheduling appointments
What do the data tell us? Goal: Wait time for 1st OB appointment will be 14 days by 2006. Goal: Wait time for 1st OB appointment will be 7 days by 2010.
What do the data tell us? 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!
Why has capacity decreased? • 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) • Neighborhood Health Centers – loss of funding resulting in clinic consolidations and reduced PNC sessions • Hospitals – new rules requiring a reduction in work hours for residents and many now not choosing to allot limited hours to OB
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
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 Women’s Health Clinic – which will help us provide Interconceptual Care