Women/Maternal Health – Annual Report, October 1, 2021 – September 30, 2022

 

Priority Need: Prevent Maternal Mortality

 

The factors impacting women's health are complex and varied, ranging from social-emotional issues, environmental impact, health insurance status, access to health care, birth spacing, and any number of other factors, including the social determinants of health, or the conditions in which individuals are born, grow, live, work and age. Improving women’s health throughout the lifespan is an essential component to bettering the health and wellness of Georgia’s women. The Office of Women’s Health promotes and supports a myriad of efforts to improve the health of all women. Over the past year, Women’s Health continued to focus on improving access to health care, including access to the most effective forms of contraceptives and preconception health to promote women's health prior to pregnancy. The all-encompassing goal to promote health equity for all Georgians, which is emphasized throughout all domains, is reflected in the Women/Maternal Health section of the report.

 

Maternal mortality was identified as a priority need for Georgia in 2020 with a strategic focus on increasing the percentage of women who receive a preventive health care visit. Due to the critical need to reduce maternal mortality in Georgia, the Title V program focused on strategies that reduce maternal mortality. Understanding the factors associated with maternal mortality and morbidity is essential for improving maternal health outcomes.

 

NPM 1: Well-Women Visit

 

Preventive Medical Visit

Well-woman visits are important to a woman’s overall health and well-being. One of the many benefits of these visits is the opportunity for women to discuss their health and to prevent and/or help identify serious health concerns before they become life-threatening. Programmatic activities and strategies undertaken during the reporting year promoted routine well-woman visits to support the health care needs of women.

 

The Breast and Cervical Cancer Program (BCCP) collaborated with district and partner providers to improve preventative care for women by meeting its CDC service goals and achieving core indicators for breast and cervical cancer prevention services. New CDC Guidelines were provided, and the annual objectives and measures were revised in the State Action Plan Table based on the updated guidance.

 

The Family Planning (FP) Program collaborated with public health district leaders to identify opportunities for increasing access to preventive health screenings that are part of FP. The number of women receiving FP and preventive screening services decreased during the COVID-19 pandemic as staff were redirected to pandemic related services. A plan for service expansion was developed including a plan to increase the number of staff available to provide FP services.

 

Current Year:

Women’s Health continues to support activities to meet or exceed the CDC service goals and core indicators and to provide well-woman or preconception visits. The BCCP continues to provide breast and cervical cancer screening and diagnostic services to low income, uninsured, and underinsured women to reduce health disparities for priority population groups, including Black women who have higher rates of breast and cervical cancer incidence and mortality, Hispanic or Asian women at risk for cultural/language barriers, women aged 40 to 64 for breast cancer screening, women aged 21 to 64 for cervical cancer screening, and those who have never or rarely been screened. 

 

The BCCP updated its program manual to reflect the latest guidance from the CDC and public health nurse protocols to improve preventative care. The program has also developed and distributed brochures and posters to the health districts to increase awareness of breast and cervical services, as well as educate the public of the importance of screenings. The BCCP will continue to engage its collaborative network of partners and utilize surveillance data to ensure Georgia women at risk for health disparities and unequitable cancer outcomes receive breast and cervical cancer screening services, diagnostic follow-up, and linkage to care.  

 

The BCCP has installed a new, electronic case management module in eight of its health districts to improve the quality of electronic records associated with breast and cervical services and to help streamline the management of care. 

 

The FP program has provided preventive health screenings to over 4,000 so far this year including screening for cervical cancer, sexually transmitted infections and HIV, and clinical breast exams.

 

Maternal Mortality Review Committee

The Georgia Maternal Mortality Review Committee (MMRC), led by Women’s Health, is a multidisciplinary committee that reviews all pregnancy-associated deaths occurring among Georgia residents. Nurse abstractors obtain medical records, autopsies, and police reports to create a case narrative summarizing the events leading up to the death. A Licensed Clinical Social Worker interviews family members or other key informants to learn contextual information the decedent’s social determinants of health, experiences with health care, and events surrounding the death, and includes this information in the case narrative. The MMRC meets quarterly and determines pregnancy-relatedness, cause of death, preventability, contributing factors, and recommendations for prevention on each death reviewed. Women’s Health enters data on each case into the Maternal Mortality Review Information Application (MMRIA) hosted by CDC. Women’s Health also creates reports, disseminates findings, and collaborates with partners to ensure recommendations from the MMRC are implemented.

 

During the reporting period, the MMRC completed the review of 2019 and 2020 cases and began reviewing 2021 cases, meeting the goal of reviewing all deaths within two years of the date of death. Data entry for 2018, 2019, and 2020 cases were completed. A fact sheet on data from 2015 to 2017 was published to the DPH website and disseminated to partners and stakeholders. The fact sheet also included key recommendations that supported the need to obtain more autopsies on pregnancy-associated deaths and extend Medicaid coverage up to one year postpartum, two key pieces of legislation passed by the Georgia General Assembly.

 

Key Informant Interviews continued as part of the review process. During the review of 2019 cases, 37 of the 66 cases (56%) outreached on had a completed interview. For 2020 cases, 45 out of 80 cases (56%) outreached on had a completed interview. Currently for 2021, the completion rate has been 65%. The primary reason interviews are not completed is due to lack of accurate contact information for the informant.

 

Efforts were made to provide support for MMRC members, including establishing a process to provide financial support for members who are unable to participate on the committee as part of their job duties. A self-care plan was created for MMRC staff and committee members which includes the development of a list of resources, such as meditations and breathing exercises that can be used before, during, and after MMRC meetings. A self-care training and vicarious trauma training was also provided for committee members.

 

The review process was revised to incorporate more discussion on each case. Members now meet in subcommittees to discuss approximately 2 cases in depth and complete the Committee Decisions Form prior to the MMRC meeting. At the MMRC meeting, all members review the case and provide input on the final determinations.

 

Current Year:

The MMRC is currently reviewing 2021 cases and identifying 2023 cases for review. Currently, all cases are being reviewed within two years of the date of death. 

 

Women's Health has been working to incorporate more community-level and contextual information into case narratives to better understand the social determinants of health impacting maternal mortality. Abstractors began incorporating county-level health indicators from the Community Vital Signs Dashboard into case narratives. Informant interviews have continued, and the qualitative information is now integrated into the case narrative to tell a more comprehensive story of the decedent’s experiences during health care encounters. 

 

Quality improvement activities have been implemented based on findings from the MMRC Data Quality Report developed by CDC on a quarterly basis. 

 

A report on 2018 to 2020 data was developed and includes qualitative and quantitative analysis on the pregnancy-related mortality ratio, causes of pregnancy-related deaths, qualitative descriptions of contributing factors, and recommendations to prevent deaths. The report will be disseminated during the current year to the community and diverse group of partners and stakeholders working to prevent pregnancy-related deaths. Women’s Health has also been working with Emory University to develop a qualitative analysis report focused on mental health conditions among pregnancy-associated deaths. 

 

The MMRC staff will coordinate with various programs, including GaPQC, Perinatal Psychiatry, Education and Community Engagement (PEACE) for Moms, Maternal and Child Health programs, and the ECHO to ensure programs are implementing recommendations from the MMRC. 

 

Related Legislation:

Senate Bill 338 passed in April 2022, extending last year’s expansion of postpartum coverage under Medicaid from six months to one year following the end of the pregnancy. This bill also provides lactation care and services to pregnant and lactating women and children who are breastfeeding or receiving their mother's milk.

 

House Bill 977 passed in April 2022, which will provide $500,000 to fund a comprehensive care management pilot for high-risk pregnancy populations. This bill also provides $680,000 to fund a pilot program to perform echocardiograms of pregnant and postpartum women to address maternal mortality.

 

Levels of Maternal Care

Women’s Health implements the Levels of Maternal Care Designation Program. Through the program, hospitals may voluntarily apply for a designation to verify their level of care. To achieve a designation, hospitals must complete a site survey with The Joint Commission (TJC) based on standards developed by the American College of Gynecology and Obstetrics, and the Society for Maternal-Fetal Medicine. Women’s Health contracts with TJC to provide funding to reduce the cost of the survey.

 

In the reporting year, DPH revised regulations to allow for a Level IV designation, which was previously not available to hospitals. The regulations were also revised to align standards with those set forth by the American College of Gynecology and Obstetrics and the Society for Maternal-Fetal Medicine.

 

Women’s Health also established the contract with TJC to implement the Maternal Levels of Care Verification Program, which was announced in March 2022. All hospitals seeking a Level II and Level III designation in Georgia are required to use the TJC program. Level I hospitals have the option of using TJC or receiving a survey through DPH. One hospital completed the process was designated as a Level IV for maternal services in the fall of 2022.

 

Current Year:

Women’s Health has continued to work with The Joint Commission (TJC) to designate hospitals according to their level of maternal care. Currently, ten hospitals are completing the application process with TJC and Women’s Health has been meeting with hospitals to help promote the program and provide technical assistance on preparing for the application. Sharing information about the verification process has been a focus in the current year. Presentations to the RPC Medical Directors during their quarterly meeting and hospitals during the GaPQC annual conference were forums to promote the Levels of Maternal Care program. 

 

Other Women/Maternal Health Programs

 

Georgia Perinatal Quality Collaborative (GaPQC) Maternal Initiatives

Led by Women’s Health, the Georgia Perinatal Quality Collaborative (GaPQC) supports birthing hospitals in implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundles. Georgia was accepted as an AIM state in October 2017 to lead the implementation of the AIM Obstetric Hemorrhage (HMG) and Severe Hypertension (HTN) patient safety bundles in the state’s birthing hospitals.

 

In the reporting year, 44 hospitals participated in the HMG initiative and 50 hospitals participate in HTN. GaPQC continued to support HMG hospital teams during the sustainability phase to promote ongoing quality improvement (QI). Three key sustainability strategies were implemented to help sustain the gains of our HMG facilities. The first is utilization of Regional Maternal Outreach Educators to provide ongoing training to hospital teams in Georgia’s six public health regions. In collaboration with the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Women’s Health supported an ‘OB Emergencies’ workshop and instructor training for the Maternal Outreach Educators to build knowledge and skills related to obstetric emergencies, including postpartum hemorrhage, hypertension disorders of pregnancy, and maternal sepsis. Two maternal educators became instructors and have provided this training to obstetric, emergency department, medical/surgical intensive care, and critical access clinicians in their regions. Additionally, GaPQC received supplemental AIM funding and recruited an Improvement Advisor (IA) to ensure focus on the AIM HMG and HTN bundles and to provide internal feedback on learning opportunities to help sustainability efforts. The IA began outreach to all AIM facilities in August 2022 offering improvement coaching and provided education on GaPQC’s newest initiative, Cardiac Conditions in Obstetrical Care (CCOC). Women’s Health and the Maternal and Child Health Epidemiology team continued to provide HMG outcome data for facilities that were enrolled in the initiative to support ongoing QI. 

 

The MMRC identified the leading causes of pregnancy-related maternal deaths between 2015-2017 to be cardiovascular and coronary conditions and cardiomyopathy with a large Black-White disparity gap. GaPQC launched the CCOC AIM bundle in 2022. An interest survey was disseminated to identify hospitals interested in joining the cardiac initiative with approximately 30 hospitals saying ‘yes’ or ‘maybe’ to enrollment. GaPQC decided to officially launch the CCOC initiative in June 2022. Extensive planning went into preparing for the launch of the CCOC bundle which included the formation of a multidisciplinary working group and subgroups focusing on creating products that address key bundle elements. The working group and four subgroups met monthly during the reporting period and are creating products to support hospital teams with bundle implementation. The four subgroups include Intentional Cardiac Screening, Clinician and Patient Education, Acute Management of the Cardiac Patient, and Consultation and Referral. Recruitment for the workgroups is ongoing to ensure multidisciplinary representation of specialties (e.g., Maternal and Fetal Medicine, Cardiology, Family Medicine, Emergency Medicine, Obstetrics and Gynecology, Midwifery, Anesthesiology, etc.). The CCOC bundle kick off webinar was held on March 1, 2022 with national AIM physicians and leads presenting about the importance of improving cardiac outcomes, especially in Black birthing patients. Recruitment and the official launch date was June 7, 2022. Georgia is the first state in the country to implement the CCOC AIM bundle and the GaPQC team presented on the National Network for Perinatal Quality Collaboratives (NNPQC) webinar on August 10, 2022 to share initial plans and learnings to support other PQCs with this bundle. The team also presented on the CCOC initiative at the Annual Georgia Perinatal Association meeting in September 2022. 

 

To support perinatal QI efforts in rural hospitals, eight rural hospitals received an additional year of state funding. Rural facilities received a Rural Hospital Achievement Award in October 2021 at GaPQC’s annual meeting to celebrate the collective impact on Severe Maternal Morbidity (SMM) for HMG and HTN. Rural facilities were encouraged to participate in IA sessions and to share their improvement efforts with the wider collaborative.  In this reporting period, a partnership was formed with the Community Care Initiative (AIM CCI) to build on the existing quality improvement efforts underway at hospitals by focusing on using maternal safety bundles in nonclinical settings. This effort will enhance existing maternal quality improvement initiatives and maximize impact within the state. GaPQC participated on an exploratory call regarding metrics for the AMI CCI initiative and a connection to the Maternal and Child Health Epidemiology team was made for further data requests.  

 

For Quarter 4 2021, 59% (33 out of 56) AIM hospitals submitted data for HTN structure/process measures. The submission percentage was 61% (34 out of 56) for Quarter 1 2022 and 46% (26 out of 56) for Quarter 2 2022. GaPQC initiated a data transformation project in Q2 2022 to improve user experience with maternal data submission and to create easier access to facility and collaborative wide data. Backend production for data submission via Survey 123 and the GaPQC data dashboard occurred throughout 2022 with potential launch in winter 2022. Due to several factors including GaPQC’s data transformation project, AIM HTN metric updates, and staff transitions in the Maternal and Child Health Epidemiology department, there were delays in Q3 2022 data collection and subsequent provision of hospital reports. Communication with GaPQC facilities is ongoing regarding data transformation and submission expectations including the extended deadline for data submission.  

 

GaPQC launched a two-phased approach to build capacity in health equity and translate strategies into action and meaningful change across the state. Phase I launched in August 2020 with the Health Equity and Implicit Bias Virtual Learning Series. In partnership with the Institute for Perinatal Quality Improvement, SPEAK UP Against Racism trainings for clinical teams and leadership were purchased and offered to health care providers to build knowledge around racial bias in healthcare, build a culture of equity, and develop specific action plans. Hospitals are currently in Phase II which focuses on translating knowledge into action. Implicit bias virtual training was provided using the March of Dimes online curriculum for 100 members of the GaPQC leadership team, Advisory Council, and maternal and neonatal committee members. Women’s Health continues to work with partners and clinicians who completed implicit bias training to assess Race, Ethnicity and Language (REaL) data collection processes at their respective institutions and implement their action plans. Efforts to reduce disparities in severe maternal morbidities and adverse maternal and early child health outcomes in Georgia continued to be a priority in the reporting year with hospitals disaggregating their quarterly process measure data by Race/Ethnicity and reporting the number of providers and staff completing implicit bias training/education. 

 

Women’s Health is transitioning focus to the CCOC AIM bundle and incorporating Respectful and Equitable Care into all active initiatives. They are continuing to build capacity and create a culture of equity, including systems for reporting, response, and learning through partnerships with organizations to support improving population level outcomes for mothers and infants. The March of Dimes partners with Women’s Health in the health equity work and the partnership with Healthy Mothers, Healthy Babies Coalition of Georgia (HMHBGA) supports policy and clinical implementation workgroups. Building on the foundational work of AIM, Women’s Health will participate in AIM Clinical Community Integration to address preventable maternal mortality and severe maternal morbidity among pregnant and postpartum women outside of hospital and birthing facility settings. 

 

GaPQC hosted monthly webinars for current initiatives. The hypertension webinars focused on the process and structure measures for the AIM bundle. The hemorrhage initiative moved into sustainability in September 2021 and all webinars are archived in Microsoft Teams. The 2021 GaPQC Annual Meeting was held on October 14 and 15, 2021 to celebrate the tremendous efforts and impact hospitals have made, as well as to recommit to improving health outcomes and providing equitable care for all mothers and babies throughout Georgia.

 

Current Year:

GaPQC continues to support the AIM Patient Safety Bundles by providing technical assistance to birthing hospitals across the state to implement the HMG, HTN, and CCOC patient safety bundles. Currently, 83% (58 of the 70) birthing hospitals have participated in at least one initiative with 73% (51 of 70) birthing hospitals participating in the hypertension initiative and 17% (12 out of 70) in the cardiac initiative. The HMG initiative moved into sustainability in September 2021 and GaPQC continues to support hospitals around sustainability efforts through IA coaching sessions, regional education, and HMG outcome data.  

 

GaPQC’s newest initiative focusing on maternal cardiac conditions has moved out of the planning stage and is now in implementation. There are 12 hospitals actively enrolled in the CCOC initiative which include 8 healthcare systems. The multidisciplinary cardiac work group continues to meet monthly, providing strategic direction for GaPQC’s cardiac initiative. The four subgroups also meet monthly and focus on creating products to address key bundle interventions. To support hospitals with the educational components of the CCOC bundle, a cardiac lecture series was developed starting in September 2021, and built out through June 2023. The goal for these lectures is to provide foundational education across disciplines on maternal cardiac conditions. Key takeaways and a connection to specific CCOC bundle elements have been built into the lectures. Presentations and webinar recordings are available on the GaPQC website for access by all teams and partners. 

 

GaPQC continues to disaggregate HTN and Cardiac outcome data by Race/Ethnicity and hospitals will report Race/Ethnicity for process measure data. Analyses will be completed to measure the impact on absolute disparity reduction. The GaPQC Improvement Advisor is providing mentorship to hospitals on strategies to improve respectful and equitable care and will collect efforts underway in the state to share the bright spots. During the current year, GaPQC produced clinician and patient education resources which will be disseminated to AIM facilities focused on cardiac screening across all care settings, acute management of the cardiac patient, and maternal cardiac warning signs. GaPQC is also continuing to build on efforts to create a culture of patient and family engagement, share stories for improvement, and empower patients utilizing Speak Up Against Racism. 

 

Data transformation is a priority for GaPQC. Data submissions that were postponed began again in March 2023. Survey platform assessment is planned for 2023 as feedback is received on the new data submission process. A Women’s Health Epidemiology team, led by a Medical Epidemiologist, was developed to provide dedicated support to Women’s Health and assist with continuous improvement around GaPQC data.

 

GaPQC is assessing sustainability readiness for HTN while encouraging birthing facilities to join the CCOC initiative. Educational needs assessments will be ongoing through different mediums including coaching sessions, webinar discussions, workgroup meetings, and surveys. GaPQC is assessing capacity and opportunities to synergize for greater impact including with other maternal health projects in the state and share learnings, locally and nationally, as the first perinatal quality collaborative in the country to implement the AIM CCOC patient safety bundle.

 

Minding the Gap (MTG) Advisory Group

The Minding the Gap (MTG) Advisory Group was developed by Emory University to reduce the racial gap in severe maternal morbidity (SMM) and adverse maternal and early child health outcomes and provide actionable evidence to policymakers, community organizations, and health systems. Title V staff served on the MTG Advisory Group in the reporting year, which was in its second year of a five-year study. The study has three aims: 1) Analyze birth and hospital discharge data to examine racial disparities in SMM during delivery and postpartum; 2) Analyze Medicaid data to evaluate impact of Planning for Healthy Babies (Georgia’s Medicaid Inter-Pregnancy Care Program) on severe maternal morbidity by race/ethnicity; and 3) Postpartum intervention at Grady Memorial Hospital for women who have cardiovascular risk for severe maternal morbidity. In the reporting year, 28 in-depth interviews were conducted with postpartum clients from Grady Hospital. The interviews addressed clients’ postpartum care experiences, including reason for attendance or absence, their postpartum visit, and any facilitators or barriers to care. The findings are being used to inform decision making for reducing disparities in maternal morbidity and mortality. 

 

Current Year:

The MTG Advisory Group continues meeting and the Women’s Health Director and the Women’s Health Medical Epidemiologist currently participate in the group. Progress continues to be made on the three aims. Quantitative analyses of birth and hospital discharge data (Aim 1) and Medicaid data from Planning for Healthy Babies (Aim 2) is currently being completed. Interviews with Planning for Healthy Babies clients (Aim 2) were completed this year and a report is being developed. Once finalized, the report will be shared with the state’s Care Management Organizations. The postpartum intervention (Aim 3) has recruited over one hundred women into the randomized clinical trial. The intervention cohort receives enhanced postpartum care, and the control cohort receives standardized postpartum care. The clinical trial will continue for one more year. Qualitative work was completed with Grady patients to inform the development of the clinical trial and manuscripts on that work are currently being developed.  

 

Maternal Mental Health

Women’s Health contracts with the Emory Brain Health Center to implement the Perinatal Psychiatry, Education and Community Engagement (PEACE) for Moms. PEACE for Moms is a perinatal psychiatry access program that increases Georgia’s capacity to provide mental health care during the perinatal period. The PEACE for Moms program aims to: 1) Consult with providers with prescriptive authority who are treating perinatal patients with mental health conditions and provide one-time evaluations with patients when needed; 2) Train providers to manage mental health conditions in the perinatal period; and 3) Increase access to skills groups to prevent perinatal depression.

 

PEACE for Moms continued to provide consultations to providers on mental health treatment and began offering face-to-face consultations with patients of enrolled providers who require further assessment. In January 2022, PEACE for Moms launched the first Mothers and Babies group to prevent perinatal depression.

 

The program presented at various meetings and conferences to promote the program and increase the number of providers and therapists enrolled. A new website was developed that includes resources and toolkits for providers.

 

The program consulted with Lifeline for Moms and participated in the Lifeline for Moms network to promote ongoing program improvement.

 

Women’s Health also continued to partner with Healthy Mothers, Healthy Babies Coalition of Georgia (HMHBGA) to train peer support group facilitators on perinatal mental health and provide peer support groups virtually. HMHBGA developed and launched Maternal Mental Health online classes through Pickles & Ice Cream, a virtual education platform. Curriculum for a Maternal Substance Use class was also developed.

 

Women’s Health also contracted with Postpartum Support International, Georgia Chapter (PSI GA) to provide trainings on perinatal mood and anxiety disorders for providers.

 

Current Year:

Women’s Health continues to contract with the Emory Brain Health Center to implement the Perinatal Psychiatry, Education and Community Engagement (PEACE) for Moms. PEACE for Moms continues to provide consultations and face-to-face assessments with patients of registered providers. PEACE for Moms provides skills groups using the Mothers and Babies curriculum for pregnancy and postpartum patients. The program is also working with Mothers and Babies to become trainers to increase the availability of the program throughout the state. PEACE for Moms, in partnership with Women’s Health, established a Reproductive Mental Health ECHO during the current year. The ECHO includes a curriculum that participants will complete in live ECHO sessions held monthly. 

 

Women’s Health also partners with Healthy Mothers, Healthy Babies Coalition of Georgia (HMHBGA) to train peer support group facilitators on perinatal mental health and provide peer support groups virtually. Maternal Mental Health and Maternal Substance Use classes are offered online. Women’s Health is also contracting with Postpartum Support International, Georgia Chapter (PSI GA) to provide trainings on perinatal mood and anxiety disorders for providers.

 

Maternal Health ECHO

The DPH Maternal Health ECHO project was created to provide clinical and community education on key findings and recommendations from the Georgia Maternal Mortality Review Committee (MMRC). Maternal Health ECHO project sessions are held virtually on the 3rd Wednesday of each month to increase the accessibility of information and tools for practice to clinicians and community advocates in underserved areas of our state. Each session is accredited to provide 1.0 AMA PRA Category 1 Credit or 1.0 ANCC contact hour. Alliance for Innovation on Maternal Health (AIM) bundles are used in each session to provide consistent evidence-based recommendations for action, including targets for health equity. Attendees consist of Physicians, APRNs, Social Workers, and a wide range of Community Advocates and Members. Typical attendance for sessions is approximately 50 attendees, with some specialty sessions (e.g., Cardiac Conditions, Reproductive Life-planning) attracting 70+ participants.

 

From October 2021 to September 30, 2022, the Georgia Department of Public Health held 7 Maternal Health ECHO project sessions. Sessions in July, August, and September of 2022 were cancelled or rescheduled due to speaker conflicts. Session topics from October 2021 to September 20, 2022 included: Hypertensive Complications of Pregnancy (October 2021); Community Coordination and Models for Optimal Care for Cardiac Complications of the Perinatal Period (November 2021); Screening, Referral, and Consultation to build a Cardio-Obstetric Network in Georgia (January 2022); Prevention of Primary Cesarean Section in Women of Size (February 2022); Community-focused Postpartum Cardiac Care (April 2022); Connections between Preeclampsia and Future Cardiac Outcomes (May 2022); Key Recommendations for Action from the Georgia MMRC (June 2022).

 

Current Year:

From October 2022 to May 2023 the Georgia Department of Public health held 6 Maternal Health ECHO project sessions. The April 2023 session was cancelled due to staff attendance at the CDC MMRIA User Meeting Conference.

 

Session topics from October 2022 to May 2023 included: Reproductive Life-Planning and Contraceptive Access for Women with Chronic Health Conditions (October 2022); Clinical Pearls for Screening and Treatment of Mental Health Conditions (November 2022); Community Resources for Perinatal Services and Support (January 2023); Health Information Exchanges for Continuity of Care Between Hospitals (February 2023); Medication Assisted Therapy for Opioid Use Disorders in Pregnancy (March 2023), Lived Experiences of Rural Prenatal Care Systems (May 2023).

 

Planned session topics from July to September 2023 include: Nursing and Public Health Care Coordination for High-Risk Pregnancies (July 2023); Culture of Safety and Team building for Response to Obstetric Hemorrhage (August 2023); Metabolic Complications of Pregnancy and Postpartum Health (September 2023).

 

Family Planning

Georgia’s Family Planning program provides leadership, guidance, and resources to Georgia’s 18 public health districts in the development and provision of resources that increase the access of family planning services to women. The Family Planning program offers patient-centered, comprehensive health care services designed to provide women support to plan the birth of their children, reduce unintended pregnancies, determine effective birth control methods, and improve the well-being of families statewide.

 

Women’s Health continued to promote and increase access to family planning services by launching Phase III of its marketing campaign to increase awareness of family planning services in the health departments. Site visits with public health districts began in November 2021 to garner insight on district level implementation of family planning. A total of nine hybrid site visits were completed both virtually and in-person. Information gathered from the site visits were used to improve the delivery of family planning services and inform the content of the quarterly Women’s Health Coordinators meetings.

 

In early 2022, a comprehensive family planning preceptor program started in three public health districts with sites located in Valdosta, Augusta, and Macon. An eight-week series of women’s health courses for new nurses is also being provided. One of the challenges in FP service provision has been in providing equal access to long-acting reversible contraceptive methods (LARCs) in all locations. Rural counties often only had the midlevel providers needed for LARC services available onsite a few days each month. It was determined that the Georgia public health nurse protocol legislation would allow RNs to provide the most demanded LARC method, the contraceptive implant. In collaboration with the manufacturer, the first RN insertion training was completed in August for 13 RNs with plans for additional trainings over the next reporting cycle. Georgia is the first state in the country to train and utilize RNs to insert contraceptive implants.

 

Current Year:

Hybrid site visits continue to be conducted in the public health districts virtually and in-person. Best practices, successes, challenges, and lessons learned continue to be shared during the site visits. Women’s Health District Coordinator quarterly meetings continue to provide Family Planning staff with updates on best practices, as well as opportunities for shared learning. A family planning campaign was developed to educate the public about family planning services. A total of 123 nurses completed DPH’s Women’s Health Exam Training through December 2022. These trainings include an overview of the Family Planning program to help increase nurses’ knowledge of Family Planning services. Training will continue throughout the remainder of the current year. The Family Planning Manual was also updated to include tools for family planning education. A virtual Family Planning conference was held in March of 2023 for Georgia’s public health Family Planning nurses in collaboration with OB/GYNs from Emory University who special in complex family planning care. Over 400 nurses and nurse practitioners participated in the training.

 

Women’s Health continues to promote family planning services and increase access to contraception, particularly LARCs, by increasing the available inventory in local health departments and increasing the workforce available to provide family planning services. The program set a goal of increasing the unduplicated number of women served in family planning by 25% from the previous year’s baseline (39,000) and is currently on target to achieve its goal. All districts continue to maintain staff who precept new staff. Regional family planning preceptor programs have been implemented in Valdosta, Augusta, Macon, and Dalton which provide districts additional opportunities to refer new nurses for comprehensive preceptorship.

 

The program continues to provide nurses with the skills they need to be successful as the first state in the country where RNs provide insertions of contraceptive implants. The FP program has completed three contraceptive implant insertion trainings and one removal training and scheduled one more of each type of training before the end of the the current year. 63 RNs have completed insertion training and 18 have completed removal training so far this year.

 

Perinatal Case Management

Perinatal Case Management (PCM) is a voluntary program that is implemented in the public health departments. PCM allows for a case manager to assist a pregnant woman with identifying special needs and facilitates access to medical, nutritional, social, psychosocial, educational, and other services to improve health outcomes of mother and baby.

 

Plans were underway to increase the number of county health departments providing PCM services from 112 to 115 by the end of 2022. Marketing materials (i.e., post cards and brochures) used to promote PCM benefits have been distributed to all public health districts for use by the PCM Case Managers and the pregnant women enrolling in PCM. The PCM program was collaborating with the Child Occupant Safety Program (COSP) to increase participation in the car seat program in all counties and providing education to pregnant mothers on safely transporting their child. DPH continued providing technical assistance on the PCM module, education, training, and updates of the PCM program to all district PCM Case Managers on the health outcomes for at risk women. PCM continued collaborating with Oral Health to distribute dental kits to pregnant women in the public health districts that enroll in the PCM program to promote good oral health during pregnancy.

 

Current Year:

In the current year, the goal of 115 county health departments providing Perinatal Case Management (PCM) services was achieved.   

 

Women’s Health continues to collaborate with internal and external partners to improve communication and PCM workflow. Remote trainings are provided on the Visual Health Net PCM Module process and assistance is provided to districts with any technical concerns with the PCM module. Virtual meetings are conducted with Care Management Organizations and the Department of Community Health representatives to resolve issues with data files. Women’s Health also completes virtual annual site visits that include PCM enrollment performance. 

 

The Office of Women's Health is maximizing the synergy between PCM services and breastfeeding education. PCM services integrate educational materials, webinars, and social media platforms to increase staff breastfeeding knowledge. Information is also provided on perinatal mental health during PCM training to increase staff knowledge. 

 

Maternal and Child Health Information and Resource Center

DPH continued to work with the existing Maternal and Child Health Information and Resource Center that operates the MCH resource hotline and website to include resources and referrals that identify and treat chronic illnesses such as hypertension, heart disease, obesity, and diabetes.

 

Current Year:

DPH has maintained the partnership with the existing Maternal and Child Health Information and Resource Center that operates the MCH resource hotline and website to provide resources and referrals.

 

Priority Need: Promote Oral Health to All Populations

 

NPM 13: Preventive Dental Visit

 

Oral Health

The Office of Oral Health continued to promote oral health among all populations, with a special emphasis on promoting oral health care services among pregnant women. Oral Health staff served on advisory boards and work groups for external partners including HMHBGA, Georgia Department of Early Care and Learning (DECAL), Georgia Cancer Control Consortium Human Papilloma Virus (HPV) workgroup, and the Georgia Bureau of Investigations (GBI), among other stakeholders. The Georgia Academy of Family Physicians and the Georgia OBGYN Society Oral Health program continued to create a more robust state oral health surveillance system by identifying gaps in data, researching data sources to fill gaps, and dedicating resources to incorporating sources. The Office of Oral Health partnered with Augusta University as subject matter experts to enhance the 100 Million Mouths Campaign which specialized in enhancing the curriculum at medical schools with the goal of increasing oral health knowledge among newly trained physicians and other allied health professional.

 

Oral Health continued to collaborate with both internal and external partners to provide oral health resources to pregnant women and caregivers of young children. District program staff were continuously provided updates and resources that help empower them to provide care, services, and education for MCH populations, including but not limited to, free continuing education opportunities, toolkits, guidelines, best practices, and recommendations from national oral health and MCH organizations.

 

In the reporting year, approximately 600 oral health resources bags were distributed throughout the state. The resource bags contain an adult toothbrush, two types of infant toothbrushes, floss, toothpaste, intraoral wipes for cleaning after nursing or bottle feeding, a brochure on health oral habits/behaviors, and a baby book on oral health. Public health district oral health program staff, district public health nurses, perinatal coordinators, home visitation workers, and external partners such as HMHBGA distributed the resource bags.

 

Oral Health funded the addition of four state supplemental oral health questions to the Georgia PRAMS survey, in addition to the two standard core oral health questions. With a combination of six questions related to oral health in PRAMS, future data will give a more complete picture of burden of disease, specific challenges and barriers, and information to help strategize on best solutions. Data from the additional questions are expected to be available in the upcoming year. The PRAMS oral health fact sheet continues to be shared with external partners. The Oral Health Epidemiology role transitioned to the MCH Epidemiology Section.

 

Oral Health disseminated the message of the importance of drinking fluoridated water at all ages to pregnant and parenting women through HMHBGA and the Home Visiting program. Eleven virtual fluoride training presentations were provided to community water plant operators across the state to ensure Georgia remains one of the top states in the country in terms of access to fluoridated water. Currently, approximately 96% of Georgia residents on community water have access to fluoridated water through the Community Water Fluoridation Program. The Fluoridation Administrator attended numerous meetings with fluoridation persons across the country and other CDC grantee states to foster collaboration and shared learning.

 

Current Year:

Oral Health continues to promote oral health among all populations, with a special emphasis on promoting oral health care services among pregnant women. Oral Health staff continue to serve on advisory boards and work groups for external partners. The Georgia Academy of Family Physicians and the Georgia OBGYN Society Oral Health program continues to create a more robust state oral health surveillance system by identifying gaps in data, researching data sources to fill gaps, and dedicating resources to incorporating sources. 

 

Oral Health plans to continue to collaborate with both internal and external partners to provide oral health resources to pregnant women and caregivers of young children. District program staff are continuously provided updates and resources that help empower them to provide care, services, and education for MCH populations, including but not limited to, free continuing education opportunities, toolkits, guidelines, best practices, and recommendations from national oral health and MCH organizations. 

 

Oral Health continues to promote an oral health awareness campaign and provide Pregnancy Oral Health Resource Bags that contain an adult toothbrush, two types of infant toothbrushes, floss, toothpaste, intraoral wipes for cleaning after nursing or bottle feeding, a brochure on health oral habits/behaviors, and a baby book on oral health. Resource bags are distributed through district oral health program staff, district public health nurses, perinatal coordinators, and external partners such as HMHBGA. Approximately 800 resource bags have already been distributed.

 

Oral health social media videos are shared with key partners and outside stakeholders. Partners and stakeholder are encouraged to share videos with their organizational networks and post on their respective websites.