Prenatal Care Referrals Help Address North Philadelphia's High Infant Mortality
Starting in October 1995, Temple University Hospital expanded a pilot program to address infant mortality in North Philadelphia and provide a full range of primary care and preventive services.
The program had demonstrated that an aggressive outreach and prevention effort can significantly reduce infant morbidity and mortality and may reduce hospital costs for newborns.
Temple planned to reorganize segments of its primary care and obstetrics and gynecology services into one center, the Temple Center for Women's Health (TCWH).
- TCWH engaged in outreach activities aimed largely at agencies serving pregnant women. Activities included:
- Presentations on prenatal care to community organizations.
- Visits to psychosocial agencies serving as referral sources.
- Participation in health fairs.
- Workshops on health issues.
- Tours of TCWH for community organization representatives.
- A child-care open house.
- And distribution of information packets.
- TCWH established linkages with medical, education and psychosocial institutions and agencies in the community.
- The outreach effort helped TCWH achieve 3,042 referrals for prenatal care during the grant period, according to the project director.
The Robert Wood Johnson Foundation (RWJF) provided partial support for this project with a grant of $321,456 from October 1995 to September 1998.
Inadequate prenatal care and poor infant health have long been problems in North Philadelphia, where Temple University Hospital is located. Of 6,411 live births in Temple's Primary Obstetric service area in 1991, 20.7 percent received inadequate prenatal care and 15.1 percent resulted in low-birthweight infants. The infant death rate was 16.7 per 1,000 live births, down from a high of 23.1 in 1989, but still higher than the national average of 8.9 in 1991.
No private obstetricians worked in the area, and other hospitals and the state department of health were cutting back services in the area. Approximately 90 percent of pregnancies were unplanned. More than 15 percent of mothers delivering at Temple were crack cocaine users, and more than 40 percent smoked cigarettes during pregnancy. Few women receive regular cancer screenings, and breast cancer death rates in Philadelphia significantly exceed state and national averages.
In 1989, Temple's Department of Obstetrics, Gynecology, and Reproductive Sciences launched the Temple Infant and Parent Support Services (TIPSS), a pilot program to address infant mortality. The program had five components:
- Outreach to community organizations that provided referrals.
- Follow-up field contacts with prospective clients and their families.
- Evaluation and development of a multidisciplinary treatment plan for each client. TIPSS also provided van transportation and child care.
- Implementation of the treatment plan, including care coordination, counseling, group support sessions, and specialty referrals.
- Transition planning, including housing, employment, and schooling assistance, as well as transfer of care to a primary care physician after the baby's first birthday.
The program demonstrated that an aggressive outreach and prevention effort can reduce infant morbidity and mortality significantly and may reduce hospital costs for newborns. Compared to area benchmarks, the pilot project produced reductions in substance abuse by pregnant women, infant deaths, and low-birthweight babies, and increases in immunizations and prenatal appointments. However, TIPSS could serve only 300 deliveries per year, a small fraction of the births in the hospital's service area.
The purpose of this grant from RWJF was to provide partial support for the integration and expansion of the TIPSS program across Temple's entire outpatient obstetrical, gynecological, and family planning clinic populations.
The expansion was to take place within Temple's planned reorganization of segments of its primary care and obstetrics and gynecology services into one center, TCWH, which would provide a full range of primary care and preventive services to the community and target major health problems, including infant morbidity and mortality, contraception, well-baby and infant care, childhood immunization, cancers and precancerous lesions of the female genital tract, and sexually transmitted diseases.
TCWH also would serve as a hub for community outreach and health promotion and prevention efforts targeting the entire family. In its proposal to RWJF in August 1995, Temple estimated that if the TIPSS approach were applied to all of its obstetrical patients, it would have resulted in a reduction in hospital charges for newborns alone of $25 million over the last three fiscal years.
The RWJF grant was used to hire a team of outreach workers to:
- work in the community to identify women early in their pregnancies and facilitate their access to TCWH's services;
- assist in the development and promotion of family-centered health promotion services.
The team included a nurse coordinator, a social worker, and a child-care specialist. Temple University Hospital provided free bus service to women with clinic appointments. Temple's Department of Obstetrics, Gynecology, and Reproductive Sciences subsidized the hiring of outreach staff.
- TCWH engaged in a variety of outreach activities, aimed largely at agencies serving pregnant women. Activities during the grant period included:
- 60 presentations on prenatal care to community organizations.
- 44 visits by the outreach team to psychosocial agencies serving as referral sources.
- Participation in 17 health fairs.
- 8 workshops on health issues, held at TCWH for both patients and outreach staff.
- 9 tours of TCWH for community organization representatives.
- A child-care open house.
- Distribution of more than 200 information packets, including bilingual fact sheets, to community organization representatives and other individuals.
- TCWH established linkages with medical, education, and psychosocial institutions and agencies in the community.
- The outreach effort helped TCWH achieve 3,402 referrals for prenatal care during the grant period, according to the project director.
- Temple did not document any cost savings from the TIPSS expansion within TCWH.
There was no dissemination effort, other than the outreach efforts within the community.
AFTER THE GRANT
Following the close of the grant period, the outreach program lost two staffers, but continued under the direction of a registered nurse who planned and implemented outreach activities in conjunction with the Temple Children's Hospital and with the assistance of Temple University Hospital.
GRANT DETAILS & CONTACT INFORMATION
Community Outreach Project to Reduce Infant Morbidity and Mortality
Temple University School of Medicine (Philadelphia, PA)
Dates: October 1995 to September 1998
Albert Reece, M.D.
Report prepared by: Jodi Miller
Reviewed by: Renie Schapiro
Reviewed by: Robert Narus
Program Officer: Rush L. Russell