Reducing Delays in Enrollment to Pregnancy Care Management (OBCM) through Workflow Improvements in a Rural Health Department

Abstract

A rural local health department in southeastern North Carolina, last completed a community health assessment (CHA) in 2015, this CHA identified a health disparity rate of 1.46 between white and minority population rates of low birth weight (LBW) births. Birth outcomes are impacted by low birth weights. These factors supported the expansion of maternal support service programs in the county through a statewide program called Pregnancy Care Management (OBCM). This program provides risk assessments and care management services for mothers through interprofessional team-based care made up of obstetric providers, nurse care managements, nutritionist, and patients. This team encourages improvements in nutrition, lifestyle modifications, and healthcare to reduce the rate of lower birth weight, improve newborn and maternal health, and reduce infant mortality disparities. Local health departments who proactively addressed improved birth outcomes through standardizing referral processes and timeframes were successful in making appropriate referrals earlier in the gestational period. This has the potential to close health disparities by addressing social determinants of health such as smoking, drug use, poor nutrition, and lack of prenatal care. This DNP project utilized the Plan, Do, Study, Act (PDSA) Cycle quality improvement (QI) methods to implement a standardized process within the rural health department that reflects adopted state policies and procedures. The PDSA Cycle QI tool was completed before implementation of the intake form and revised at 30, 45, and 60-days team meetings. This resulted in an 81% decrease in delays of contacting referred patients, and resulted in an improvement of 488% toward target state standard goals of personal contact with a referred patient within ten business days.