Priority Need: Prevent Maternal Mortality

NPM 1: Well-Women Visit

Percent of women, ages 18 through 44, with a preventive medical visit in the past year
 

NPM 1 Strategies:

1.1.a  Meet or exceed the CDC guideline of providing ≥75% of federally funded screening mammograms to women over 50 years of age.

1.1.b  Meet or exceed the CDC guideline of providing ≥20% of initial pap tests to individuals who have never or rarely been screened for cervical cancer.

1.2.a  Increase the number of LARCs utilized among women of reproductive age (15-44 years) served in local Public Health Departments by 5% annually.

Preventive Medical Visit

A well-woman or preconception visit provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunizations, which can lead to appropriate identification, treatment, and prevention of diseases to optimize the health of women before, between, and beyond potential pregnancies. A key component of a well-woman visit for a reproductive-aged woman is the development and discussion of her reproductive life plan to align with her current and future plans. Prevention, screening, and management of chronic conditions such as diabetes, and counseling to achieve a healthy weight and smoking cessation, will be advanced with a well-woman visit to promote women’s health prior to and between pregnancies and improve subsequent maternal and perinatal outcomes. The Women’s Health program will continue to support activities to meet or exceed the CDC guideline for the percent of initial cervical screening tests that are conducted among women who have never been screened or not screened within the last 10 years.

Family Planning
Women’s Health will continue to promote and increase access to family planning service particularly LARCs. Family Planning plans to launch Phase III of the marketing campaign. Site visits will be conducted with public health districts to garner insight on district level implementation of family planning. Staff will also provide an eight-week series of women’s health courses for new nurses. DPH will partner with Bixby to provide the standard LARC CME course and in-depth special courses to train family planning staff on best practice in increasing access to family planning.

Maternal Mortality Review Committee

Women’s Health will continue work with the MMRC to complete case reviews for 2017 and 2018. By the end of calendar year 2021, the MMRC will complete case reviews for 2019 and meet the goal of reviewing cases within two years of the date of death which will bring the case review current and provide much needed information to the GaPQC and other groups working to impact maternal mortality. In accordance with CDC recommendations a Key Informant Interviewer was hired in June 2020. The Key Informant Interviewer will be conducting interviews with friends, family members, or other close contacts of the deceased mother to provide information for the review committee beyond what is listed in the medical record, including information on social determinants of health. DPH will be implementing a data sharing process with Medicaid to obtain information on dates of coverage for each case and to provide abstractors with information on providers seen. DPH also plans to expand dissemination of report findings and recommendations by posting the information on the DPH website, and disseminating information to medical providers, community-based organizations, advocacy organizations, and other perinatal care workers.

Alliance for Innovation on Maternal Health Bundles

GaPQC will continue to support the AIM Patient Safety Bundles by providing support for birthing hospitals across the state to implement the Obstetric Hemorrhage and Severe Hypertension in Pregnancy Initiatives. Outreach efforts will continue to recruit new hospitals to join the 55 of the 73 birthing hospitals participating in one or both initiatives. To support hospital teams, monthly webinars will be hosted to provide expertise related to implementing the specific bundle interventions and provide one on one hospital support and technical assistance. Focus will be placed on incorporating elements of the Reduction of Peripartum Racial/Ethnic Disparities into each AIM bundle. In the fall of 2020, Women’s Health will host a Health Equity Learning Series and Training to build capacity and create a culture of equity including systems for reporting, response, and learning. Partnerships with organizations will support improving population level outcomes for mothers and infants including March of Dimes in the health equity work and HMHB as partners on the policy and clinical implementation workgroups. Building on the foundational work of AIM, we 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.

Priority Need: Promote Oral Health Among All Populations

NPM 13: Preventive Dental Visit

Percent of women who had a preventive dental visit during pregnancy

NPM Strategy 13.1: Provide oral health trainings and presentations to medical providers to increase knowledge.

The Oral Health program will continue to promote oral health among all populations, with a special emphasis on promoting oral health care services among pregnant women. The Oral Health Annex contract with the health districts in FY2020 included a recommendation to include perinatal oral health services for WIC and other public health patients. A newly developed and simplified oral health reporting tool will also reduce administrative burden on districts and allow for more time for patient care, education, and prevention services. With this tool, districts will provide monthly tracking of total clinical visits broken down by age categories, total number of prevention services (dental sealants, fluoride varnish applications, oral health screenings, and oral health education), as well as total number of pregnant women seen by district oral health program staff (either for services, screenings, or referrals). 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.

The Oral Health program will continue to promote an oral health awareness campaign and will be boosting social media videos offering short key messages on oral health geared towards pregnant women and caregivers of young children. Public Service Announcement videos will be converted to fit social media platforms like Facebook, Twitter and Instagram and will target social media pages of individuals likely to be pregnant, recently pregnant, or caregivers of young children. The videos are slated to begin in August 2020. 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 will be distributed through district oral health program staff, district public health nurses, perinatal coordinators, home visitation workers, and external partners such as Healthy Mothers Healthy Babies Coalition of Georgia.

The Oral Health program will continue 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. Due to funding received in 2020 the Oral Health program funded three additional state supplemental oral health questions to the Georgia PRAMS survey. In addition to the two standard core oral health questions and one supplemental state oral health question. With a combined 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 strategize on best solutions. This data is expected to be available mid-2021. The Oral Health program will add a full time Oral Health Epidemiologist to help support ongoing surveillance, oral health surveillance plan implementation, and data analysis.

Other Women/Maternal Health Programs

Centering Pregnancy

The Women’s Health program will continue to support public health districts in their goal to provide Centering Pregnancy services to women in the community. The Women’s Health program will collaborate with Federally Qualified Health Centers (FQIC) and evaluate the data retrieved to improve the services provided in Centering Pregnancy sites in Albany. The Women’s Health program will work with other public health districts that desire to host a Centering Pregnancy program in their community and form an alliance between the districts for support of one another. Efforts to collaborate and build communication and relationships between internal and external partners will continue. Women’s Health will collaborate with external partners to gather information on the next Basic Facilitators training for district staff in need.

Perinatal Case Management (PCM)

Women’s Health plans to increase the number of county health departments providing PCM services from 107 to 115 by 2022. The developed post cards and brochures to promote PCM benefits will be distributed to all public health districts for use by the PCM Case Managers and the pregnant women enrolling in PCM. The PCM program will collaborate with the child occupant safety program to increase participation in the car seat program for all counties and provide education to pregnant mothers on safely transporting their child. DPH will continue 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 will continue collaborating with the Oral Health program 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.

Planning for Healthy Babies (P4HB)

The P4HB working group will continue activities to create a statewide marketing and communications plan in collaboration with the four Care Management Organizations, provider organizations and community-based organizations that serve populations eligible for P4HB. The working group will continue to develop plans that amplify increasing the knowledge, understanding and utilization of P4HB services toward reducing low birth weight and very low birth weight rates, unintended pregnancies, and lowering Medicaid costs. MCH is dedicated to continuing support of P4HB by participating with community partners and provider groups toward increasing awareness of the program’s benefits for greater utilization by both participants and providers statewide.

Maternal and Child Health Information and Resource Center

The Women’s Health program will 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 to resources that identify and treat chronic illnesses such as hypertension, heart disease, obesity, and diabetes.