Improving the Quality of Perinatal Care
Enhancing the Delivery of State-of-the-Art Care
Improving pregnancy and birth outcomes means changing the way prenatal care is delivered and managed. From 2006 to 2013, LA Best Babies Network enlisted over 20 outstanding clinical sites throughout L.A. County to participate in the Healthy Births Care Quality Collaborative, which is currently referred to as the Perinatal Health Collaborative of LA (PHC-LA). These clinics integrated well-tested strategies into their daily routines to improve prenatal and postpartum care.
Network staff created a comprehensive model of care that addressed the fragmented nature of office systems. Participating clinics embraced this model, as well as the ambitious goals of the collaborative: to reduce preterm births by 20%, increase breastfeeding by 50% and raise postpartum care by 50% above baseline levels. The clinics and community-based organizations learned from one another's experiences by sharing successful strategies and by learning from each other's pitfalls.
Few areas of medicine have as much potential as improvement of the delivery of care. It takes an estimated 17 years for proven effective methods to be integrated into routine patient care in the US. The Institute of Medicine calls this the "quality chasm," which is the gap between what healthcare professionals know to be high-quality care and that which patients actually receive.
"The quality chasm is the gap between what healthcare professionals know to be high quality care and what patients actually receive."
The Perinatal Health Collaborative focuses on the patient. To solve patients' problems, participating teams rely on evidence-based research while being respectful of the patients' cultural beliefs. Providing the best possible care does not stop at the clinic door; excellent care involves linking patients to social support services such as nutrition counseling, housing programs, and other community resources that can improve their quality of life.
One of the keys to success for a collaborative is the ability to step out of comfortable roles and work with others toward a common goal. "As humans, we tend to resist change," says Janice French, CNM, MS, Director of Programs for LA Best Babies Network. She adds that it is natural to meet with skepticism when the goals are first presented. "So, you take baby steps and start with a very small change. Once you see it isn't as difficult as you thought it would be, it tends to cut down on resistance."
"We tend to resist change. So, you take baby steps. Once you see it isn't as difficult as you thought, it tends to cut down resistance." —Janice French, CNM, MS
The collaborative uses a well-established organizational method that involves planning, testing, studying the issue, and then acting on it. It allows people to make incremental shifts in procedures rather than a complete overhaul.
Taking these small steps would not be possible without the support of each health agency's leadership. The directors of the participating healthcare systems participate in monthly meetings•and conference calls with clinicians, doctors and senior management staff to discuss goals and brainstorm about how to correct problems. For example, one team faced challenges ensuring that its prenatal clients received dental care, which is an important preventive measure due to the link between periodontal disease and low birth weight. "We worked as a team with the dental clinic and changed the referral process," reported a clinic administrator. "As a result, we significantly improved the number of women receiving dental care."
To deliver the best, most up-to-date clinical care, LA Best Babies Network also provides the necessary research directly to the providers when and where they need it. With the help of the leaders of the Perinatal Health Collaborative, doctors and clinic staff are testing and treating pregnant women based on the most current scientific evidence. Prenatal care can be more complex than many other specialties because of the many medical and environmental components to track. Providers must be knowledgeable about nutrition, psychosocial changes, housing and poverty, and physical changes.
Knowing How to Communicate: Culturally and Linguistically Appropriate Care
Updated information needs to be communicated effectively to the patient and her family. Including the woman in the decision-making process is at the heart of the Collaborative's work. Clinic staff works with each woman to set goals and plan care based on her individual needs. They also work to keep educational and community resource materials up to date and organized.
"Our vision is to create a level playing field for pregnant women so they can get the best possible care regardless of where they live and how they access care."
The clinics are also committed to another core tenet of the Network's mission: providing comprehensive, culturally sensitive and linguistically appropriate perinatal care. Clinics recognized the need to address the diversity of the community they serve, not just in terms of race, but also ethnicity, language, sexual orientation, religious beliefs and disability.
Studies have shown that certain racial groups tend to suffer disproportionately from chronic disease and infection, in part because of the difficulty in accessing the healthcare system and the high cost of health insurance. But disparities can also stem from communication gaps between women and their providers that result in confusion about medical instructions.
Recording Progress: the Healthy Births Database
Serving patients well also means tracking relevant details about the care they receive. The Network worked with AJW, Inc. to develop the Healthy Births Perinatal Registry, an Internet- based, HIPAA compliant client registry, that allows members of the collaborative to input clinically useful data in a timely way. The data is used to generate reports and to plan and follow patient care. Clinics also use the database to track their progress in attaining selected quality indicators, demonstrating that women in their practice are receiving recommended education, screening, treatment, and follow-up.
"We're empowering providers so they can improve the healthcare system," says French. "Our vision is to create a level playing field for pregnant women so that everyone receives the best possible care, regardless of where they live and how they access care."