Perinatal Health Partnership Southeast Georgia

Evidence-level

Effective (About evidence-level criteria)

Description

Perinatal Health Partnership (PHP) is an in-home nursing case management program for high-risk pregnant individuals with the goal of maximizing pregnancy outcomes for mothers and their newborns and decreasing the infant mortality rate and infant illnesses. Through assessments and care coordination, outcomes are improved for these individuals, many of whom face significant barriers to care.

Operating in 12 southeast rural counties of Georgia, PHP partners with local OB/GYNs, birthing hospitals, county health departments, and others involved in perinatal care to identify early in the pregnancy those individuals considered high-risk. While only OB/GYNs, nurse practitioners, physician assistants, or primary care physicians are able to make referrals to the program, other healthcare professionals can fill out and submit a Patient Advocacy Form on behalf of the pregnant individual they would like to see participate in PHP.

Individuals are identified as being high-risk if they have:

• History of miscarriage or later pregnancy loss
• Prior premature labor/delivery
• Previous fetal/neonatal death
• Gestational diabetes or type 1 or type 2 diabetes
• Pre-eclampsia
• Incompetent cervix
• A multiples pregnancy (more than one fetus) with complications
• A fetal abnormality in the current pregnancy
• Other pre-existing medical conditions such as an autoimmune disease, epilepsy, or HIV
• A high-risk age like 17 years or younger or an advanced maternal age

PHP is a line item budget at the state, and much of its funding comes from that source. In the past, PHP secured additional funding in the form of March of Dimes grants and a 2006-2009 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant.

Services offered

• Clinical assessments of mother and baby
• In-home case management
• Care coordination including referrals for medical costs, prenatal care, prenatal education, WIC services, and other needed services
• Education for participants and their families
• Connection to needed resources

The case manager follows the mother and infant until 10 weeks postpartum. At this point, if the mother doesn't have a permanent method of birth control, an outreach worker (with the mother's permission) continues to follow up with the mother and baby until 2 years postpartum, monitoring birth control compliance as well as the baby's growth and development.

Results

According to the 2013-2014 PHP Annual Evaluation:

• 215 individuals were served and 134 live births occurred from July 1, 2013, to June 30, 2014.
• The recorded mean birthweight of singleton births was 6.83 lbs., with a mean gestational length of 37.7 weeks. Prior birth outcomes for this same group had a mean birthweight of 6.34 lbs. with a mean gestational length of 27.9 weeks.
• On average, individuals were about 8.1 weeks into the pregnancy when referred to PHP.
• 20.1% of all births were low birthweight, including pregnancies with multiples.
• Two infant deaths were recorded.
• 14% of referred patients who agreed to participate were lost to follow-up (for example, patients moved away or missed follow-up appointments). Only 1.4% of referrals refused service.
• Surveys completed by PHP participants indicate a high level of satisfaction with PHP staff.

Results from the 14th year of operation can be found in the 2014-2015 PHP Annual Evaluation.

According to the 2015-2016 PHP Annual Evaluation:

• 175 individuals were served and 105 live births occurred from July 1, 2015, to June 30, 2016.
• The recorded mean birthweight of singleton births was 6.6 lbs., with a mean gestational length of 37.5 weeks. Prior birth outcomes for this same group had a mean birthweight of 6.24 lbs., with a mean gestational length of 27.5 weeks.
• On average, individuals were 7.5 weeks into the pregnancy when referred to PHP.
• 21% of all births were low birthweight, including pregnancies with multiples.
• 0 infant deaths were recorded.
• 20.6% of referred patients who agreed to participate were lost to follow-up. Only 0.6% of referred patients refused service.
• Surveys completed by PHP participants show a very high level of satisfaction with the program.

For more information about PHP:

Raychowdhury, S., Tedders, S.H., O'Steen, G., & Jones, S. (2007). Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast Georgia. Journal of the Georgia Public Health Association, 1(1), 34-42. Article Abstract

Challenges

It's a challenge to keep PHP in the forefront of physicians' minds so that they continue to make referrals to the program. Because PHP only serves certain counties in one health district, the physicians need to think about which of their patients are eligible to participate in PHP.

PHP reported a decrease in referrals at the beginning of the pandemic, but referral numbers are now starting to increase. In addition, there was also an increase in premature and low-birthweight babies when all home visits were halted. When home visits resumed, these numbers went down.

Replication

Major buy-in from local OB/GYNs is extremely important for a program like this because they are the source for referrals. Without referrals, there is no program. Referrals can come from a variety of health professionals, but not from nurses.

It is critical to have nurses who have the heart to do home visits and who either have perinatal experience or who are willing to become educated about perinatal issues. Nurse case managers should have a passion for pregnant individuals and babies and shouldn't be afraid in any way to provide home visits in all types of environments.

Contact Information

Holly Mobley, Coordinator
Southeast Health District
912.389.4714
Holly.Mobley@dph.ga.gov