Friday, April 12, 2019 2:00 p.m. Eastern Dial In: 888.863.0985 - PowerPoint PPT Presentation

Friday, April 12, 2019 2:00 p.m. Eastern Dial In: 888.863.0985 Conference ID: 8066336 Slide 1 Slide 1

Speakers Kelly Bower, PhD, MSN/ MPH, RN Assistant Professor, Johns Hopkins School of Nursing S. Michelle Ogunwole, MD General Internal Medicine Research Fellow, Johns Hopkins Bloomberg School of Public Health Andrea N. William s-Muham m ad, CBD, CPD, CCBE Baltimore Community Doulas Birth/ Reproductive Justice & Equity Advocate Slide 2 Slide 2

Disclosures  Dr. Bower has no real or perceived conflicts of interest.  Dr. Ogunwole has no real or perceived conflicts of interest.  Ms. Williams-Muhammad would like to disclose her affiliation with the Black Mammas Matter Alliance (National Collaborator- Policy Working group) Slide 3

Objectives  Explore racial disparities in maternal health under a quality and safety lens  Review evidence for mechanisms perpetuating racial disparities in maternal health for African American women  Discuss the postpartum period as a point of intervention to reduce racial disparities in maternal health outcomes Slide 4

Forgotten Aim IOM Domains of Quality Care Slide 5

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Racial Disparities in Maternal Health Slide 7

Disparities in Mortality • Minorities represent half of all US births • Disproportionate burden of mortality faced by racial minorities • African American women are 3 to 4 times more likely to die as a complication of pregnancy Creanga. J of Women’s Hlth; 2014 Slide 8

Disparities in Morbidity • Maternal morbidity can lead to severe long term health consequences • Profound racial disparities exist for maternal morbidity and severe maternal morbidity • African American women have the highest rates for 22 of 25 severe morbidity indicators used by the Center for Disease Control Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015 (HCUP, AHRQ ) Slide 9

Causes of Pregnancy related Deaths by Race Ethnicity Colorado 2008—2012 Delaware 2009—2015 Georgia 2012—2014 Hawaii 2015 Illinois 2015 North Carolina 2014—2015 Ohio 2008—2015 South Carolina 2014—2017 Utah 2014 Slide 10

Racial Disparities in Maternal Health Howell. Clin Obstet Gynecol; 2018 Slide 11

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Postpartum Period Slide 13

Timing Colorado 2008—2012 Delaware 2009—2015 Georgia 2012—2014 Hawaii 2015 Illinois 2015 North Carolina 2014—2015 Ohio 2008—2015 South Carolina 2014—2017 Utah 2014 Slide 14

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Immediate Postpartum Period: Home Visiting Programs Slide 17

https:/ / mchb.hrsa.gov/ maternal-child-health-initiatives/ home-visiting-overview Slide 18

MIECHV Program Services For pregnant women & children birth to 5: • Education/ support of health promoting practices (e.g. - breastfeeding, infant care, child development, positive parenting, family planning) • Support of maternal-infant bonding & attachment • Enhancement of social support systems • Assistance with goal setting, education, employment & child care • Linkage to community resources Slide 19

MIECHV Program Evidence 1 • Improve maternal and newborn health • Reduce child injuries, abuse, and neglect • Improve school readiness and achievement • Reduce domestic violence • Improve family economic self-sufficiency • Improve coordination and referral for community resources and supports 1Home Visiting Evidence of Effectiveness (HomVEE), https:/ / homvee.acf.hhs.gov/ Slide 20

Benefits, Challenges, and Opportunities Benefits Challenges Opportunities • Prioritize provision • Integration of • Become familiar of services to home visiting into with home visiting families living in health care system programs in your at-risk service area communities • Learn referral • 2-5 years process, make postpartum referrals, consider strategies for ‘warm hand offs’ Slide 21

Immediate Postpartum Period: Doula Services with Reproductive Justice Presentation Slide 22

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Mainstream Doula vs. Community Doula … ..The “community doula” model of care goes beyond the industry standard COMMUNITY DOULA MAINSTREAM DOULA MODEL MODEL Support to birthing families in Two visits during the prenatal period • • ALL areas of their lives Attendance at birth • Impact not only birth outcome but Two postpartum visits • • also stability (therefore health) of the family Slide 24

Domains of Postpartum Doula Care Emotional Support • Physical Comfort • Self-Care • Infant Care • Information • Advocacy & Referral • Partner/ Father Support • Support Mother and Father/ Partner with • Infant Care Support Mother and Father/ Partner with • Siblings Care Household Organization • McComish et. al. JOGNN; 2009 Slide 25

H.O.M.E. The Baltimore Community Doula program has blended these domains into: H.O.M.E Honor. Observe. Mentor. Empower. Slide 26

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Postpartum Doula • Having a doula provides the birthing person with the opportunity to ask questions Actively plan and have a say in • care and the type of care • Impact on the overall health in the postpartum and beyond Slide 28

Late Postpartum Period: Chronic Disease Prevention and Cardiovascular Health Slide 29

Society of Maternal Fetal Medicine White Paper: Pregnancy as a Window into Future Health One mechanism for improving CVD mortality would be to improve • awareness and prevention strategies Pregnancy is one time that women are very likely to access • healthcare system Pregnancy and postpartum = opportunity to identify risk factors • for future cardiovascular and overall health Pregnancy is a stress test :presumably those with medically • complicated pregnancies fail the stress test and show us they have underlying CVD Even though there is a clear link between these complications and • CVD; many women are not aware, and no national guidelines about future screening Slide 30

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Promising Models Slide 32

Barriers: Transitions of Care and Handoffs Slide 33

Barriers: Healthcare Access Women of color are more likely to be • uninsured or have Medicaid coverage Although there is guaranteed healthcare • coverage during pregnancy; women lose coverage 60 days after delivery Slide 34

Where to Begin? Slide 35

As we think about which policies need to be supported—which ones will address disparities? Slide 36

Things Can Vary by State • In Texas, most maternal deaths occur more than 42 days postpartum. • The majority of maternal deaths in 2012 were to women enrolled in the Medicaid program at the time of delivery. Slide 37

Stratify Data for Most at Risk Groups Slide 38

Q&A Session Press *1 to ask a question You will enter the question queue Your line will be unmuted by the operator for your turn A recording of this presentation w ill be m ade available on our w ebsite: www.safehealthcareforeverywoman.org Slide 39

Provider Next Safety Action Series Wellness Mini- Series Session 1 A Look a t the Current Sta te of Prov id er W ell-Being a nd Its Effect on Pa tient-Centered Ca re Ap ril 18 11:30 a .m . Ea stern Tim e Linda Drozdowicz, MD Robert Krause, DNP, APRN-BC Fellow, Child & Adolescent Psychiatry Lecturer, Yale Child Study Center Yale University School of Nursing Click to Register Slide 4 0