III.E.2.c. State Action Plan - Women/Maternal Health - Application Year - Alaska - 2021
Search Term:
Plan for the application year: Oct 2020 - Sept 2021
The NPM for the Women/Maternal Domain, percent of women, ages 18 through 44, with a preventive medical visit in the past year, was continued from prior years. Priorities for the women’s domain include prevention of substance misuse among women of childbearing age, connection to behavioral and mental health information, resources and services, mitigating the impact of ACEs through enhanced social supports and safe, and healthy relationships. NPM 1 continues to be the best indicator for WCFH work in the women’s domain, given that much of the section’s efforts involve supporting providers who care for women. Women who receive preventive medical care are more likely to receive screening and intervention related to priority needs including substance misuse, mental health needs and exposure to interpersonal violence.
The new ESM, number of dissemination products created based on analyses of survey data on women’s preventive healthcare visits (and description), focuses on sharing information and data related to the NPM and targeting a variety of audiences to increase the impact of the messages. By informing and educating health care providers through publications such as the Epidemiology Bulletin, providers will be more aware of trends in women receiving preventive care and may increase efforts to encourage patients to schedule visits. Public Service Announcements (PSAs) and other efforts to target the public will educate women about the purpose and importance of an annual preventive health visit. Reports and data briefs for public health program managers or other decision-makers will provide evidence and data to support interventions to make preventive health visits more available and accessible for high risk populations.
NPM Strategy 1.1: Partner with community-based partners to provide patient navigation and health education information about women’s health to disparate populations.
The Ladies First Program, the State of Alaska’s CDC-funded breast and cervical cancer screening program located in WCFH, pays for cancer screening and diagnostic services for women ages 21-64 with incomes < 250% FPL. Ladies First maintains approximately 150 formal agreements with private and publicly-funded screening and diagnostic providers to enroll and screen eligible women. The program coordinates closely with Alaska Medicaid to assure a seamless transition in coverage of costs for low income women referred for cancer treatment. Women who have not had cervical cancer screening in over 5 years are 60% more likely to be diagnosed with cervical cancer, and low-income women are more likely to not have received a Pap test in over 5 years. In order to increase cervical cancer screening rates, Ladies First will continue to partner with outreach and screening navigators, community organizations, and non-traditional partners.
Ladies First maintains contracts for community outreach and screening navigation in two regions of the state with low screening rates and is expanding to two other regions in 2020. These contractors provide educational opportunities to the public, barrier relief (e.g., transportation, day care, language assistance), and assistance with accessing appointments. Also, the program is developing educational initiatives to increase awareness of the need for screening services among people experiencing disabilities and low health literacy populations. Furthermore, Ladies First will expand their work with health care providers on quality improvement efforts to improve screening rates among patients seeking care at Alaska’s community health centers and private practices (see NPM 1.2 below). Finally, Ladies First will begin working with employers on health education opportunities for their employees, as well as developing screening-friendly workplace policies. Supporting all of this work is data analysis and visualization through GIS technology to track screening rates, changes based on geography, age, race, socio-economic status, and other relevant factors.
Ladies First activities focused on increasing cervical cancer screening rates in Alaska help connect underserved and high risk populations with health care providers who then can screen for and address other health concerns, e.g., ACEs, substance use, and other risk and protective factors in the woman’s life.
NPM Strategy 1.2: Identify and partner with public and private providers statewide to improve and expand their preventive health services through ongoing quality improvement models.
The Ladies First Program is in the third year of health systems interventions to increase clinic-level screening rates for breast and cervical cancer screening. Their work to date has included quality improvement projects at FQHCs and private practices through partnerships with the Alaska Primary Care Association (APCA) and private quality improvement agency contractors. As the clinics participating in the quality improvement projects have shown increases in screening rates ranging from 1% to 4% over the past year, this work will be expanded in the coming year to include improvements in the broader context of women’s health service delivery. Staff in WCFH working in both the Ladies First and Family Planning Programs will collaborate on a new contract to provide quality improvement to improve women’s health by better understanding populations served and using data to measure improvement and identify best practices in family planning and related preventive health services (e.g., breast and cervical cancer screening). Many of the patients receiving care at participating clinics will fall within the Ladies First's priority population: women who are un/underinsured who are at or below 250% of the federal poverty level, and those who are rarely or never screened for breast and cervical cancer.
Since family planning and contraceptive needs are a main driver for women in their reproductive years to seek any medical services, improvements in electronic patient management systems that result in better serving all preventive health needs of these women when they do seek family planning services will allow providers to address other emergent health concerns.
Finally, improving connectedness between providers and their patients on an ongoing, routine basis also helps preserve the continuity of health services during a collective community emergency, as has been the case during the COVID-19 pandemic. Maintaining this connectedness, as well as connecting more individuals with medical homes can help practices more quickly re-integrate routine preventive services for their patient populations, as well as address any emergent health needs that occur during the disaster response. See the “cross-cutting issues” section for more discussion.
NPM Strategy 1.3: Review all pregnancy-associated deaths through the Maternal Child Death Review (MCDR), generate actionable recommendations for all preventable deaths and increase awareness about the MCDR program among the public, clinicians and policymakers.
Through efficient and comprehensive death review, the Alaska Maternal Child Death Review (MCDR) program endeavors to use data to develop substantive public health recommendations that influence legislation, policy, and practice changes that result in reduced mortality. The MCDR Committee reviews all pregnancy-associated deaths in Alaska and determines which are pregnancy-related, identifies cause(s), contributing factors, and preventability. The MCDR was recently awarded a CDC grant to support the maternal mortality review program and to transition review data to the CDC-maintained Maternal Mortality Review Information Application (MMRIA) database. The program recently welcomed a new maternal case abstractor to the team. As a dual-board certified OB-GYN/MFM, this contract provider brings important clinical expertise to the maternal mortality review component of MCDR. By standardizing the collection of high-quality data using MMRIA, MCDR is working towards systematic analysis and sharing of information about the multifactorial issues that cause disparities behind maternal mortality. With guidance from CDC, MCDR is working to improve the feasibility of recommendations by ensuring that recommendations map to causative factors and include specific “who, what and when” components.
Through a partnership with the Alaska State Hospital and Nursing Home Association (ASHNHA), the MCDR is expanding its visibility among facilities and hospital-based providers. The program is utilizing partnerships with Tribal and community-based services to broaden the cultural and professional diversity of the committee, which will improve the cultural sensitivity and relevance of its recommendations. MCDR produces quarterly reports containing all of the recommendations generated by child and maternal mortality reviews. Additionally, the program aims to release at least one publication per year specific to maternal mortality.
NPM Strategy 1.4: Collect, analyze and disseminate data on women’s preventive healthcare visits (e.g. PRAMS and BRFSS).
Starting with 2016 births, the Alaska PRAMS Phase 8 survey has collected data on receipt of health care visits by adult women in the 12 months before getting pregnant, including “regular check-ups at their family doctor’s office or their OB/GYN’s office,” or “visits for family planning or birth control.” The Phase 8 survey will continue to be used by PRAMS through 2022 births and possibly longer. Since these two questions are among the core questions on the Phase 8 survey, comparison data from other states are also available. Alaska PRAMS and Title V epidemiologists will continue to monitor the results of these survey questions as part of the annual Title V Needs Assessment update process. During FY21, specific efforts will be undertaken to publish a series of dissemination products focused on the topic of women’s preventive health visits. The data and associated public health recommendations for women will be disseminated to a variety of audiences through a topic-specific Epidemiology Bulletin, Public Service Announcements (PSA) and social media messages, and other formats targeting public health program managers and decision-makers.
MCH Epidemiologists will monitor Alaska BRFSS results related to women’s preventive health visits and work with the BRFSS program located in the Section of Chronic Disease Prevention and Health Promotion (CDPHP) to disseminate data. CDPHP is currently transitioning its online data dissemination from Alaska IBIS to a Tableau-based system. The Title V MCH Epidemiologists will provide support to the Alaska BRFSS program during this transition period and collaborate with CDPHP to coordinate data dissemination efforts and establish standards for the Division. These ongoing efforts are part of the Division’s new Strategic Plan as well as efforts to seek Public Health Accreditation.
Using data from PRAMS, BRFSS, and other sources, WCFH staffs will also work to develop and publish a comprehensive women’s health publication, through an online and/or electronic “reports and recommendations” format. The purpose of this publication will be to increase provider and public awareness and understanding of key risk factors affecting women’s health in Alaska, and current practice recommendations for improving Alaska women’s health. Key data points will include percent of women with a past year preventive health visit, unintended pregnancy, breast and cervical cancer screening rates, and key risk factors for maternal morbidity. These indicators will be stratified by relevant demographic categories, which may include region of residence, age, and race.
NPM Strategy 1.5: Engage hospitals and birthing facilities in data-driven, collaborative quality improvement focused on reducing severe maternal morbidity in partnership with the Alaska Perinatal Quality Collaborative (PQC).
Since its launch in January 2019, the AKPQC embarked on several health care quality improvement initiatives and hosted its 2020 annual summit in collaboration with the Alaska Maternal Child Death Review Program. AKPQC initiatives engage multiple hospitals, freestanding birth centers, and midwifery practices from around Alaska in collaborative quality improvement.
In partnership with the Alliance for Innovation on Maternal Health (AIM), the first maternal AKPQC initiative focuses on reducing severe maternal morbidity due to hypertension in pregnancy. Participating facilities implement evidence-based practices to support quick and appropriate response to a hypertensive emergency. Facilities are supported by WCFH through as-needed technical assistance and data analysis, monthly facility team calls, and quarterly learning sessions that emphasize mutual mentoring and learning. This initiative currently engages 9 hospitals covering 65% of Alaska’s total births.
In January 2020, the AKPQC launched an initiative to improve transfers of care and urgent transports from planned community (home or freestanding birth center) births. Alaska consistently has the highest proportion of community births in the US. Community births are safest when community birth providers are integrated into the mainstream health care system with seamless access to consultation, transfer of care, and emergency transportation when necessary. The AKPQC is partnering with hospitals, freestanding birth centers, and midwifery practices to establish local transfer committees, promote standardized evidence-based guidelines for transfers/transports, and to develop systems and processes for protected multidisciplinary case reviews. Currently, there are five communities or regions are participating in this initiative – Juneau, Mat-Su, Anchorage, Homer, and Fairbanks.
The AKPQC is also partnering with the Alaska Substance-Exposed Newborns Initiative (SENI) as the foundation of its first neonatal initiative. More information about SENI can be found under the Infant domain.
Upon the expected conclusion of the birth transfer and hypertension initiatives in the spring of 2021, the AKPQC will convene its membership to plan and develop new initiatives based on current data and statewide priorities. AKPQC leaders and members have expressed a desire to address maternal mental health and substance exposure, so it is likely that future initiatives of the AKPQC will align more closely with the new 5-year needs assessment priorities.
Plan for the application year: Oct 2020 - Sept 2021
The NPM for the Women/Maternal Domain, percent of women, ages 18 through 44, with a preventive medical visit in the past year, was continued from prior years. Priorities for the women’s domain include prevention of substance misuse among women of childbearing age, connection to behavioral and mental health information, resources and services, mitigating the impact of ACEs through enhanced social supports and safe, and healthy relationships. NPM 1 continues to be the best indicator for WCFH work in the women’s domain, given that much of the section’s efforts involve supporting providers who care for women. Women who receive preventive medical care are more likely to receive screening and intervention related to priority needs including substance misuse, mental health needs and exposure to interpersonal violence.
The new ESM, number of dissemination products created based on analyses of survey data on women’s preventive healthcare visits (and description), focuses on sharing information and data related to the NPM and targeting a variety of audiences to increase the impact of the messages. By informing and educating health care providers through publications such as the Epidemiology Bulletin, providers will be more aware of trends in women receiving preventive care and may increase efforts to encourage patients to schedule visits. Public Service Announcements (PSAs) and other efforts to target the public will educate women about the purpose and importance of an annual preventive health visit. Reports and data briefs for public health program managers or other decision-makers will provide evidence and data to support interventions to make preventive health visits more available and accessible for high risk populations.
NPM Strategy 1.1: Partner with community-based partners to provide patient navigation and health education information about women’s health to disparate populations.
The Ladies First Program, the State of Alaska’s CDC-funded breast and cervical cancer screening program located in WCFH, pays for cancer screening and diagnostic services for women ages 21-64 with incomes < 250% FPL. Ladies First maintains approximately 150 formal agreements with private and publicly-funded screening and diagnostic providers to enroll and screen eligible women. The program coordinates closely with Alaska Medicaid to assure a seamless transition in coverage of costs for low income women referred for cancer treatment. Women who have not had cervical cancer screening in over 5 years are 60% more likely to be diagnosed with cervical cancer, and low-income women are more likely to not have received a Pap test in over 5 years. In order to increase cervical cancer screening rates, Ladies First will continue to partner with outreach and screening navigators, community organizations, and non-traditional partners.
Ladies First maintains contracts for community outreach and screening navigation in two regions of the state with low screening rates and is expanding to two other regions in 2020. These contractors provide educational opportunities to the public, barrier relief (e.g., transportation, day care, language assistance), and assistance with accessing appointments. Also, the program is developing educational initiatives to increase awareness of the need for screening services among people experiencing disabilities and low health literacy populations. Furthermore, Ladies First will expand their work with health care providers on quality improvement efforts to improve screening rates among patients seeking care at Alaska’s community health centers and private practices (see NPM 1.2 below). Finally, Ladies First will begin working with employers on health education opportunities for their employees, as well as developing screening-friendly workplace policies. Supporting all of this work is data analysis and visualization through GIS technology to track screening rates, changes based on geography, age, race, socio-economic status, and other relevant factors.
Ladies First activities focused on increasing cervical cancer screening rates in Alaska help connect underserved and high risk populations with health care providers who then can screen for and address other health concerns, e.g., ACEs, substance use, and other risk and protective factors in the woman’s life.
NPM Strategy 1.2: Identify and partner with public and private providers statewide to improve and expand their preventive health services through ongoing quality improvement models.
The Ladies First Program is in the third year of health systems interventions to increase clinic-level screening rates for breast and cervical cancer screening. Their work to date has included quality improvement projects at FQHCs and private practices through partnerships with the Alaska Primary Care Association (APCA) and private quality improvement agency contractors. As the clinics participating in the quality improvement projects have shown increases in screening rates ranging from 1% to 4% over the past year, this work will be expanded in the coming year to include improvements in the broader context of women’s health service delivery. Staff in WCFH working in both the Ladies First and Family Planning Programs will collaborate on a new contract to provide quality improvement to improve women’s health by better understanding populations served and using data to measure improvement and identify best practices in family planning and related preventive health services (e.g., breast and cervical cancer screening). Many of the patients receiving care at participating clinics will fall within the Ladies First's priority population: women who are un/underinsured who are at or below 250% of the federal poverty level, and those who are rarely or never screened for breast and cervical cancer.
Since family planning and contraceptive needs are a main driver for women in their reproductive years to seek any medical services, improvements in electronic patient management systems that result in better serving all preventive health needs of these women when they do seek family planning services will allow providers to address other emergent health concerns.
Finally, improving connectedness between providers and their patients on an ongoing, routine basis also helps preserve the continuity of health services during a collective community emergency, as has been the case during the COVID-19 pandemic. Maintaining this connectedness, as well as connecting more individuals with medical homes can help practices more quickly re-integrate routine preventive services for their patient populations, as well as address any emergent health needs that occur during the disaster response. See the “cross-cutting issues” section for more discussion.
NPM Strategy 1.3: Review all pregnancy-associated deaths through the Maternal Child Death Review (MCDR), generate actionable recommendations for all preventable deaths and increase awareness about the MCDR program among the public, clinicians and policymakers.
Through efficient and comprehensive death review, the Alaska Maternal Child Death Review (MCDR) program endeavors to use data to develop substantive public health recommendations that influence legislation, policy, and practice changes that result in reduced mortality. The MCDR Committee reviews all pregnancy-associated deaths in Alaska and determines which are pregnancy-related, identifies cause(s), contributing factors, and preventability. The MCDR was recently awarded a CDC grant to support the maternal mortality review program and to transition review data to the CDC-maintained Maternal Mortality Review Information Application (MMRIA) database. The program recently welcomed a new maternal case abstractor to the team. As a dual-board certified OB-GYN/MFM, this contract provider brings important clinical expertise to the maternal mortality review component of MCDR. By standardizing the collection of high-quality data using MMRIA, MCDR is working towards systematic analysis and sharing of information about the multifactorial issues that cause disparities behind maternal mortality. With guidance from CDC, MCDR is working to improve the feasibility of recommendations by ensuring that recommendations map to causative factors and include specific “who, what and when” components.
Through a partnership with the Alaska State Hospital and Nursing Home Association (ASHNHA), the MCDR is expanding its visibility among facilities and hospital-based providers. The program is utilizing partnerships with Tribal and community-based services to broaden the cultural and professional diversity of the committee, which will improve the cultural sensitivity and relevance of its recommendations. MCDR produces quarterly reports containing all of the recommendations generated by child and maternal mortality reviews. Additionally, the program aims to release at least one publication per year specific to maternal mortality.
NPM Strategy 1.4: Collect, analyze and disseminate data on women’s preventive healthcare visits (e.g. PRAMS and BRFSS).
Starting with 2016 births, the Alaska PRAMS Phase 8 survey has collected data on receipt of health care visits by adult women in the 12 months before getting pregnant, including “regular check-ups at their family doctor’s office or their OB/GYN’s office,” or “visits for family planning or birth control.” The Phase 8 survey will continue to be used by PRAMS through 2022 births and possibly longer. Since these two questions are among the core questions on the Phase 8 survey, comparison data from other states are also available. Alaska PRAMS and Title V epidemiologists will continue to monitor the results of these survey questions as part of the annual Title V Needs Assessment update process. During FY21, specific efforts will be undertaken to publish a series of dissemination products focused on the topic of women’s preventive health visits. The data and associated public health recommendations for women will be disseminated to a variety of audiences through a topic-specific Epidemiology Bulletin, Public Service Announcements (PSA) and social media messages, and other formats targeting public health program managers and decision-makers.
MCH Epidemiologists will monitor Alaska BRFSS results related to women’s preventive health visits and work with the BRFSS program located in the Section of Chronic Disease Prevention and Health Promotion (CDPHP) to disseminate data. CDPHP is currently transitioning its online data dissemination from Alaska IBIS to a Tableau-based system. The Title V MCH Epidemiologists will provide support to the Alaska BRFSS program during this transition period and collaborate with CDPHP to coordinate data dissemination efforts and establish standards for the Division. These ongoing efforts are part of the Division’s new Strategic Plan as well as efforts to seek Public Health Accreditation.
Using data from PRAMS, BRFSS, and other sources, WCFH staffs will also work to develop and publish a comprehensive women’s health publication, through an online and/or electronic “reports and recommendations” format. The purpose of this publication will be to increase provider and public awareness and understanding of key risk factors affecting women’s health in Alaska, and current practice recommendations for improving Alaska women’s health. Key data points will include percent of women with a past year preventive health visit, unintended pregnancy, breast and cervical cancer screening rates, and key risk factors for maternal morbidity. These indicators will be stratified by relevant demographic categories, which may include region of residence, age, and race.
NPM Strategy 1.5: Engage hospitals and birthing facilities in data-driven, collaborative quality improvement focused on reducing severe maternal morbidity in partnership with the Alaska Perinatal Quality Collaborative (PQC).
Since its launch in January 2019, the AKPQC embarked on several health care quality improvement initiatives and hosted its 2020 annual summit in collaboration with the Alaska Maternal Child Death Review Program. AKPQC initiatives engage multiple hospitals, freestanding birth centers, and midwifery practices from around Alaska in collaborative quality improvement.
In partnership with the Alliance for Innovation on Maternal Health (AIM), the first maternal AKPQC initiative focuses on reducing severe maternal morbidity due to hypertension in pregnancy. Participating facilities implement evidence-based practices to support quick and appropriate response to a hypertensive emergency. Facilities are supported by WCFH through as-needed technical assistance and data analysis, monthly facility team calls, and quarterly learning sessions that emphasize mutual mentoring and learning. This initiative currently engages 9 hospitals covering 65% of Alaska’s total births.
In January 2020, the AKPQC launched an initiative to improve transfers of care and urgent transports from planned community (home or freestanding birth center) births. Alaska consistently has the highest proportion of community births in the US. Community births are safest when community birth providers are integrated into the mainstream health care system with seamless access to consultation, transfer of care, and emergency transportation when necessary. The AKPQC is partnering with hospitals, freestanding birth centers, and midwifery practices to establish local transfer committees, promote standardized evidence-based guidelines for transfers/transports, and to develop systems and processes for protected multidisciplinary case reviews. Currently, there are five communities or regions are participating in this initiative – Juneau, Mat-Su, Anchorage, Homer, and Fairbanks.
The AKPQC is also partnering with the Alaska Substance-Exposed Newborns Initiative (SENI) as the foundation of its first neonatal initiative. More information about SENI can be found under the Infant domain.
Upon the expected conclusion of the birth transfer and hypertension initiatives in the spring of 2021, the AKPQC will convene its membership to plan and develop new initiatives based on current data and statewide priorities. AKPQC leaders and members have expressed a desire to address maternal mental health and substance exposure, so it is likely that future initiatives of the AKPQC will align more closely with the new 5-year needs assessment priorities.
To Top
Narrative Search