Intermountain Healthcare - Community Prenatal Program

Overview

The mission of the Intermountain Healthcare Community Prenatal Program is to expand access to pre- and post-natal care and improve birth outcomes and breastfeeding rates for underserved women. The primary target group is refugee, immigrant, low-income and uninsured women. The program provides prenatal, delivery and postpartum care by certified nurse midwives, together with perinatology consultation and co-management from maternal-fetal medicine physicians to offer seamless care for both low-risk and high-risk obstetric patients.

Impact

In all areas measured in one cohort of Hispanic women, birth outcomes were better than comparison data, including the state of Utah, Utah’s Hispanic women, the country and the Healthy People 2010 goals. Significant decreases were noted in Caesarean section rates and pre-term and low-birth-weight-at-term infants. The primary C-section rate for these women was 6.2 percent compared with Utah’s 13.5 percent and the U.S. norm of 20.3 percent. Utah Hispanic women have higher rates of pre-term and low-birth-weight infants at term than the other groups reported — after program intervention, these women dropped their pre-term and low-birth-weight infant rates by 43 percent and 35 percent, respectively.

Challenges/success factors

Success factors included the following:

• Visionary leadership that understood that the best way to improve community health is to improve the health of women and their infants.
  
• The mission to remove financial barriers and provide subsidized care from numerous sources to uninsured pregnant women.
  
• Clinical sites within the community that provide care to patients in their native language.
  
• A long and close partnership between the nurse-midwives and maternal-fetal medicine that allows collaborative care along the continuum from low-risk to high-risk.

Future direction/sustainability

• A focus on expanding access through additional school-based health centers with the goal of providing care where women of childbearing age and stage of life are.
  
• Foundation commitment to long-term funding based on program mission and outcomes.
  
• Continued use of alternative funding ideas, for example, contracts for sharing payments.
  
• Strategic plan for sharing of resources and personnel between health centers, for example, one provider sees patients from three to four school-based health centers with center 1 providing the portable ultrasound and supplies, center 2 providing the pharmacy assistance program, center 3 providing overall scheduling, etc.

Advice to others

• Use nurse-midwives as the primary caregivers for prenatal, labor and delivery, and postpartum care.
  
• Have a group of physicians, perinatologists or obstetricians who can provide high-risk management so that care for these patients is limited to two provider groups who work closely together and share the same goals.
  
• Utilize creative financing; negotiate with hospitals to help fund these clinics.
  
• Market the program internally — to OB department head, head of women and newborns, hospital CEO, other operations people — as well as to community groups.
  
• Partner with appropriate clinical sites within the community, such as community clinics, volunteer clinics and community health centers.

Contact: Terry E. Foust, AuD, FAAA
Administrator, Intermountain Community and School Clinics
Telephone: 801-442-3029
E-mail: terry.foust@imail.org