Panel Slides
Jump to Slides:
Judi Consalvo 1 2 3 4 5 6 7 8 9 10
Beth Collins Sharp 11 12 13 14 15 16 17 18
Sharon Schindler Rising 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Slide 1
Meeting the Health Care Needs of Underserved Women
Web Seminar
May 19, 2011
http://www.innovations.ahrq.gov
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Slide 2
How to Access Closed Captioning
Closed Captioning:
- Click on the link, “Closed Captioning,” on the top right hand corner of the participant console.
- A new window opens displaying the captioning.
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Slide 3
What Is the Health Care Innovations Exchange?
- Publicly accessible, searchable database of health service delivery innovative strategies and tools
- Successes and attempts
- Innovators’ stories and lessons learned
- Expert commentaries
- Learning and networking opportunities
- New content posted to the Web site every two weeks
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Slide 4
Innovations Exchange Web Event Series
How to find archived materials
Go to the Events & Podcasts tab on our site: http://www.innovations.ahrq.gov. A transcript of this event along with the slides will be available in a week.
Next Events
Web events in June and July—look for the announcements
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Slide 5
Innovations Exchange Web Event Series (cont.)
CNE Credit
Continuing nursing education (CNE) credit is available for this Web event. You must attend the entire event and complete the evaluation to receive one credit.
After the event, you will receive detailed information in an e-mail from programevaluations@ncqa.org on how to complete the evaluation and claim your CNE credit.
Evaluation
Please complete the evaluation even if you do not wish to receive credit. Thank you—we appreciate the feedback.
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Slide 6
Housekeeping
- No phone is necessary for this event.
- You may just stream the audio over the Web through the speakers on your computer.
- For help, notify the Vcall team through the question window at the bottom of the screen.
- To refresh your screen, hit f5.
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Slide 7
Submitting Questions
- When: Any time during the presentation
- How: Send a written question through the question window
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Slide 8
Web Seminar Objectives
At the completion of this Web seminar, you will be able to:
- Describe disparities in health care for women in underserved populations
- Describe health care challenges for women in underserved populations
- Explain the Centering Model approach to prenatal health care for women in underserved populations
- Identify evidence-based methods for providing prenatal health care for women in underserved populations.
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Slide 9
Web Seminar Agenda
Beth Collins Sharp (AHRQ):
- Describe disparities in health care for women in underserved populations
- Describe health care challenges for women in underserved populations
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Slide 10
Web Seminar Agenda (cont.)
Sharon Schindler Rising (Centering Healthcare Institute):
- Explain the Centering Model approach to prenatal health care for women in underserved populations
- Identify evidence-based methods for providing prenatal health care to women in underserved populations.
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Slide 11
Today’s Event Moderator
Beth Collins Sharp, PhD RN
Sr. Advisor, Women’s Health
U.S. Agency for Healthcare Research and Quality (AHRQ)
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Slide 12
The Health of Underserved Women in Context
2010 National Healthcare Quality Report and National Healthcare Disparities Report:
- Health care quality and access are suboptimal, especially for minorities and poor people.
- Quality is improving; access and disparities are not.
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Slide 13
The Health of Underserved Women in Context (Cont.)
Overall, some services, areas, and populations merit urgent attention, including:
- Cancer screening and management of diabetes.
- States in the central part of the country.
- Residents of inner-city and rural areas.
- Disparities in preventive services and access to care.
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Slide 14
The Health of Underserved Women in Context (Cont.)
Health Care Delivery and Systems
- Females were more likely to have a usual primary care provider than males (79.9% compared with 72.6%).
- In all years, females were more likely than males to be unable to get or delayed in getting needed medical care, dental care, or prescription medicines.
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Slide 15
The Health of Underserved Women in Context (Cont.)
Health Care Quality and Disparities in Women
- Extracts and summarizes data related to women
- From 2004 to 2007, rates of 3rd and 4th degree lacerations decreased from 40 to 32 per 1000 vaginal deliveries.
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Slide 16
Healthcare Cost & Utilization Project (HCUP) 2008 Data: Reasons for Hospital Stays
Reason
|
Male |
Female |
Pregnancy and Childbirth |
n/a
|
4.7
|
Circulatory System |
3.1
|
2.8
|
Perinatal (Newborns) |
2.3
|
2.1
|
Respiratory System |
1.8
|
2.1
|
Digestive System |
1.5
|
1.9
|
All Other Conditions |
7.8
|
9.6
|
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Slide 17
HCUP Report: Hospitalizations Related to Childbirth
1997 to 2008:
- Use of forceps to aid delivery declined by 32%, from 14% to 10%.
- 40% of all childbirth stays were billed to Medicaid, 53% to private insurers, 4% were uninsured, and the rest were other payers.
- Roughly 36% of all childbirth hospital stays in 2008 occurred in the South compared to 16% in the Northeast. The West and Midwest accounted for 26% and 23%, respectively.
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Slide 18
Affordable Care Act
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Slide 19
The Centering Model for Providing Prenatal Care to Underserved Women
Sharon Schindler Rising, MSN, CNM, FACNM
President and CEO of the Centering
Healthcare Institute, Inc.
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Slide 20
What is the Centering Healthcare Institute?
- Founded in 2001 as a non-profit
- Uses the evidence-based model of group care called Centering, which promotes major health care quality goals
- Established areas of Centering include CenteringPregnancy and CenteringParenting
- CenteringDiabetes is being piloted
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Slide 21
Centering Model and Underserved Women
- Centering Care is appropriate for all women
- Majority of Centering sites are in public clinics, FQHC’s, hospital clinics
- Contact information for the submitter.
- Centering Care has particular benefits for underserved women:
- Culturally appropriate care, often in language-specific groups
- Individual health empowerment
- Community building
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Slide 22
Imagine…
- No waiting
- Time to really listen to your patients
- Time for sharing and learning
- Saying things only once
- Better health outcomes
- Having fun
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Slide 23
Quotes:
- “This is the one thing in my week that brings me joy” - provider
- “We came at the same time and left at the same time and something happened the whole time we were there” - participant
- “This is the ‘bestest’ way I know of to receive care!” - participant
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Slide 24
CenteringPregnancy: Design
Initial intake to system as usual
- History
- Physical
- Lab work
Group of 8-12 women with similar due dates
Groups start between 12-16 weeks and meet for 10 sessions throughout pregnancy
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Slide 25
CenteringPregnancy Visit Schedule
Four sessions every 4 weeks - 16, 20, 24, 28 weeks
Six sessions every 2 weeks - 30, 32, 34, 36, 38, 40 weeks
Postpartum reunion - Between 1-2 months postpartum
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Slide 26
Components of Centering Care
Assessment
Education
Support
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Slide 27
Assessment
- Individual health care exam with provider conducted in group space
- Patients directly involved in collecting and recording their own health data
- Provider/patient contact time increased 10 fold
- Care reimbursed in the usual way
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Slide 28
Education
- Participants have time to talk in depth about important information and questions
- General session plan guides discussion
- Opportunity to explore cultural beliefs and values enhances appropriateness of content
- Group provides efficient way to share information
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Slide 29
Support
Groups provide:
- A vehicle for social change
- An opportunity to learn from each other
- Fun and interesting sharing
- Centering builds communities one group at a time
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Slide 30
Centering Essential Elements
13 Essential Elements
define the Centering model of care, including CenteringPregnancy
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Slide 31
1. Health assessment occurs within the group space
Assessment area in the group space:
- Care is normalized
- Privacy is protected
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Slide 32
2. Participants are involved in self-care activites
Self-Assessment activities:
- Weight
- Blood pressure
- Lab tests
- Other specific assessments for particular health conditions
- Self-Assessment Sheets
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Slide 33
3. A facilitative leadership style is used
Group
- Interactive
- Inquiry and dialog
- Shared experiences
- Patient centered
Class
- Didactic
- Passive
- Structured
- Provider centered
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Slide 34
4. Each session has an overall plan
5. Attention given to overall content
Personal Goals, Exercise, Stress management, Infant development, Nutrition, Childbirth preparation
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Slide 35
5. Attention is given to general content outline (emphasis may vary)
We talk about what the group wants to talk about.
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Slide 36
6. There is stability of group leadership
- Build trust
- Group history
- Continuity of care
- A provider and co-facilitator guide the group through all sessions
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Slide 37
7. Group conduct honors the contribution of each member
Group Ground Rules:
- Confidentiality
- Personally comfortable sharing
- Appropriate language translation
- Culture of respect prevails
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Slide 38
8. The group is conducted in a circle
Picture provided
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Slide 39
9. Opportunity for socializing is provided
10. The composition of the group is stable but not rigid
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Slide 40
11. Group size is optimal to promote the process
Too Few:
- Productivity issues
- Awkward
- Difficult for shy individuals
- Pressure to participate
- Didactic
Too Many:
- Limited dialogue; didactic
- Assessments challenging
- Individuals lost in the crowd
- Community building more challenging
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Slide 41
12. Involvement of family support persons is optional
- One support person
- The same one each time
- No children
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Slide 42
13. There is ongoing evaluation of outcomes
Benchmarking topics
- Patient experience
- Attendance at visits
- Health outcomes: preterm birth, method of delivery, breastfeeding
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Slide 43
Measuring the Impact of Centering Care
- Impact of CenteringPregnancy most thoroughly studied
- Results particularly pertinent for underserved women:
- Higher rates of preterm births
- May have cultural/language challenges
- Increased number of social risk factors
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Slide 44
Effects of Group Prenatal Care on Outcomes
Results from a Two-Site Matched Cohort Study
Centering groups vs. traditional care: N=458
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Slide 45
Impact of Model Effect on Outcomes
Premature infants of group patients were significantly larger than those in individual care (2397.8 versus 1989.9 grams)
Group patients maintained their premature pregnancies two weeks longer than individual care patients (34.8 weeks versus 32.6 weeks)
Moving a pregnancy along one additional week from 34 to 35 weeks gestation results in a 42 percent decrease in hospital costs
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Slide 46
Effects of Group Prenatal Care: Randomized Controlled Trial
National Institute of Mental Health
No. MH 611, 2001 through 2006; Ickovics et al., Obstetrics and Gynecology 110, 2 (August 2007): 3230–9
Study Sample (N=1,047)
Pregnant women 14 to 25 years, HIV negative
English/Spanish, public clinics in New Haven, CT and
Atlanta, GA
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Slide 47
STUDY SAMPLE, SELECT CHARACTERISTICS
|
GROUP
(n=653) |
INDIV
(n=394) |
AGE, years (range 14-25) |
20.3
|
20.6
|
EDUCATION, years (26% drop out) |
11.4
|
11.3
|
GA STUDY ENTRY, weeks |
18.0
|
18.4
|
NULLIPAROUS |
62%
|
61%
|
SMOKE, current |
21%
|
20%
|
Hx STI |
52%
|
50%
|
African American |
81%
|
74%
|
Latina |
11%
|
17%
|
Hx PRETERM BIRTH |
4.0%
|
7.1%
|
PRENATAL DISTRESS, mean |
15.2
|
13.7
|
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Slide 48
Research Outcomes: 2006 Randomized Controlled Trial
Chart showing per 1000 women in group, 40 preterm deliveries averted; 60 per 1000 for African American women
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Slide 49
PRENATAL CARE ATTENDANCE, SATISFACTION & COST
- 78% average attendance
- Less than adequate care (Kotelchuck): 26% vs 33%, OR =0.68 (.50-.91)
- Women in group care had greater satisfaction with care, (F=27.2, p<.001)
- Significantly higher prenatal knowledge and readiness for labor & delivery (each p<.001)
- Higher readiness for baby care (p=.0560)
- No difference antenatal or in delivery costs (p>0.69)
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Slide 50
“This is the one thing in my week that brings me joy” - provider
“We came at the same time and left at the same time and something happened the whole time we were there” - participant
“This is the ‘bestest’ way I know of to receive care!” - participant
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Slide 51
Centering Healthcare Institute
info@centeringhealthcare.org
www.centeringhealthcare.org
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Slide 52
Contact Us!
Please send comments and suggestions to:
info@innovations.ahrq.gov
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