long

Rural Health Care Conference

CenteringPregnancy® Model for Prenatal Care

Sara Long

Dec. 8, 2011

Centering Pregnancy Model

for Prenatal Care

Thirteen essential

elements define the

Centering model of care

Care is normalized Privacy is assured

1. Health assessment occurs

within the group space

2. Participants are involved

in self-care activities

3. A facilitative leadership style

is used

4. Each session has an overall plan

Birth Preparation

Nutrition & Infant

Feeding

Stress

Reduction

Infant

Development

Comfort &

Safety

“I’m learning that it

doesn’t matter what

we don’t talk about

because we’re

talking about what

matters to the group”

5. Attention is given to the general

content outline; emphasis may vary

6. There is stability of

group leadership Continuity of care Trust

Gro

up

his

tory

7. Group conduct honors the

contribution of each member

8. The group is conducted

in a circle

9. Opportunity for socializing

is provided

11. Group size is optimal

to promote the process

12. Involvement of support people

is optional

Anything we want to see improved….benchmarking

Patient experience

Attendance for prenatal care visits

Breastfeeding rates

Birth outcomes – gestational age and

birth weight

13. There is ongoing evaluation

of outcomes

96-97% of all women polled state they prefer receiving their prenatal care in group

References:

Ickovics JR, Kershaw TS, Westdahl C et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics & Gynecology. 2007; 110(2):330-339.

Cooper LG, LMSW; Gooding JS, BS; Gallagher J, RN, EdM, MPA; Sternesky L, MPA, Ledsky R, MBA; and Berns SD, MD, MPH. Impact of a family-centered care initiative on NICU care, staff and families. Journal of Perinatology 2007; 27: S32-S37

Grol, R., & Grimshaw, J. . From best evidence to best practice: effective implementation of change in patients’ care. The Lancet 2003; 362, 1225-1230.

Peterson AA, Berns SD, Gooding JS, et al. Meeting the Needs of Pregnant Women and Babies in a Disaster: The Role of Voluntary Nongovernmental Health Organization. Journal of Emergency Management 2007;5(1):41-46.

Words from the Wise*

Success factors in sustaining groups:

1. Dedicated, appropriate space

2. Committed administration support

(including line-items in the budget)

3. Centering coordinator with released

administrative time

4. Commitment to “opt-out”

*Sharon Rising, CNM, MSN,

Executive Director, CHI

Centering Healthcare Institute

1. Centering Site Readiness Visit

2. Initial Training

3. Reporting forms

4. Consultation on system re-design

5. Site visit and approval

558 Maple Avenue Cheshire, CT 06410

203-271-3632

info@centeringhealthcare.org

www.centeringhealthcare.org

Success factors in

management & funding

Lancet: From best evidence to best practice:

– Identifies 11 frequently used interventions,

4 directly relevant to Centering Pregnancy:

• Educational strategies

• Multi-professional collaboration

• Patient-mediated interventions

• Combination of interventions

Success factors in management

& funding

What do funders want:

• Outcomes

• Visibility/Recognition

• Outcomes

• SMART Objectives

• Outcomes

• Sustainability Plan

March of Dimes Involvement Our goal: in Virginia, to reduce preterm birth rates,

especially among pregnant population

at high risk of preterm birth.

1. Increase the number of sites and providers offering CP.

2. Improving fidelity of CP delivery to the essential elements

of the model.

3. Enrolling more pregnant women in CP.

4. Maintain women’s satisfaction with care.

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ

CT RI

MA

ME

VT

NH

AK

HI

DC

2008 March of Dimes chapter-funded

Centering Pregnancy® grants – In Blue

Assessment of

MOD-funded projects

1. Expand National Office and chapter collaboration to

develop, deploy, and evaluate CP training, TA tools, and

models and to disseminate information about CP successes

to stakeholders.

2. Build informal networks of providers at the chapter level,

to engender peer-to-peer learning.

3. Develop MOD website(s) that provide access to extensive

information about ongoing TA and coordination effects;

evaluation findings; and funding opportunities.

4. Advance CP evaluation by standardizing indicators, data

collection tools, and reporting formats.

Planning, beginning in the first year

Staff buy-in

Funding – external and internal

Enrollment

Evaluation -- process and outcome

March of Dimes survey of CP providers identified

these top sustainability success factors:

March of Dimes funding

• Provide funding for basic and advanced provider

training workshops;

• CP site infrastructure, materials, supplies, and

staff; and

• Provision of coordination and technical assistance,

including assistance with evaluation.

Reporting required

for MOD funding

1. Patient demographics.

2. Patient attendance.

3. Date of first session.

4. Patient satisfaction/self-evaluation.

5. Fidelity of CP core elements.

6. Outcome Variables.

Long-term commitment

1. Provide support for mature sites for ongoing staff training.

2. Work with grantees to ensure sustainability.

3. Support TA assistance and coordination for CP sites.

4. Support and/or collaborate in research efforts that

examine benefits, cost neutrality, and/or cost effectiveness

of CP, and help to disseminate the findings to diverse

stakeholders.

5. Advocate directly for additional support for CP with other

public and private funders, policymakers, insurance

companies, and others.

Virginia Projects VCU

Family Maternity Center of the Northern Neck

Southern Dominion Health System, Inc.

Johnson Health Services

St. Francis Family Medicine Center

Eastern Virginia Medical School

Riverside Family Practice

Augusta Health Care for Women

Community Memorial Healthcare

Three Rivers Health District

Richmond City Health District

Holston Medical Group

Shenandoah Women’s Healthcare

Southampton Memorial Hospital

Manassas Midwifery

March of Dimes

• Funding ($3,000 - $35,000)

• Consultation and TA

• Advanced Training by CHI

• CP Peer to Peer Network

Q & A

For questions about the model

or funding opportunities, contact:

Sara Long

Slong@marchofdimes.com

(804) 968-4120