AMCHP 2005 Conference PPOR – Another Opportunity for Local / State Capacity Building The Ohio Story Part I Carolyn Slack – Columbus Health Department.

AMCHP 2005 Conference

PPOR – Another Opportunity for Local / State Capacity Building

The Ohio Story Part ICarolyn 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. Ohio Franklin 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 CareBy Race / Ethnicity

Race/Eth. Ohio Franklin 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

Black:White gap largest in 1999 and 2002.

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Black White Total HP2010

Franklin County Infant Mortality 1979-2002* Rate by Race

*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 providers are not even scheduling appointments

Waiting Times for Initial OB Appointments, Franklin County

(April 1995- August 2004)

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1020

30

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6

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7

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Date of Calls for Appointments

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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?

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

Initial OB Appointment Capacity

1,516

1041

0200400600800

1,0001,2001,4001,600

No. of Appts.

May-03

Apr-04

31% DECREASE in Initial OB appointment

s!

Why has capacity decreased?

1. 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)

2. Neighborhood Health Centers – loss of funding resulting in clinic consolidations and reduced PNC sessions

3. 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 IssuesThis 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