Perinatal and Infant Health Domain

Application Year 2024

 

Priority Area: Decreasing perinatal and infant health disparities

Focus Area 1: Breastfeeding

Performance Measures:

• Continued: National Performance Measure (NPM) 4A: Percent of infants who are ever breastfed.
• Continued: NPM 4B: Percent of infants breastfed exclusively through six months. 
• Continued: Evidence-Based or- Informed Strategy Measure (ESM) 4.4: Percent of women referred for breastfeeding peer counseling support.
• Continued: ESM 4.6: Increase the percent of completed breastfeeding education training.
• Continued: ESM 4.6: Percent of women provided with in-person or telephonic breastfeeding consults/support services.

Objective 1: Increase rates of breastfeeding initiation among African American women from 63% to 75% by 2026. 

Strategies:

• Educate pregnant women about the benefits and management of breastfeeding, with priority given to subpopulations with lower rates of breastfeeding initiation and duration.
• Incorporate breastfeeding-friendly policies and training staff in the handling of breast milk at health centers, schools, and early childhood centers.
• Refer and track referral completion of women to breastfeeding services.
• Determine placement for lactation support personnel based on identified needs within the District.

Activities:

In FY24, Title V will continue to fund and support The DC Breastfeeding Coalition (DCBFC).

• Delivering Breastfeeding Services – The DC Breastfeeding Coalition (DCBFC) will continue delivering chest/breastfeeding support services at the East of the River Lactation Support Center, strategically co-located at a Children’s National Hospital primary care site. DCBFC receives referrals from pediatricians, DC Women, Infants, and Children (WIC), and the community. Consultations are held face-to-face, by video, or by telephone to meet chest/breastfeeding individuals where they are and strengthen continuity of care.
• Expanding the Lactation Workforce – DCBFC will continue to provide advanced chest/breastfeeding training to lactation support staff to create pathways to career advancement. DCBFC will lead at least one cohort of the Lactation Certification Preparation Course (LCPC)] to prepare individuals to sit for the International Board-Certified Lactation Consultant (IBCLC) exam.
• Pediatric Provider Learning Collaborative – DCBFC will continue to lead a learning collaborative for pediatricians aimed at improving evidence-based primary care practice surrounding breastfeeding assessment for pediatric patients from birth to six months of age. This important workforce development initiative will help increase the referral rate to breastfeeding support among Children’s National Medical Center patients.
• Increasing Representation among international board-certified lactation consultants (IBCLCs) – To increase the number of IBCLC candidates from underrepresented groups, DCBFC will continue to dedicate time to mentoring candidates from underrepresented groups: Indigenous Peoples, People of Color, Men, Deaf, Developing Countries, LGBTQI Community, Low Socio-Economic Individuals/Communities, Adolescents, Generation Z, and People with Differing Abilities.

DCBFC focuses on supporting African American individuals of child-bearing age in Wards 5, 7, and 8, with lower household incomes and historically lower breastfeeding rates in the District and nationwide. DCBFC also targets teens and communities federally designated as Medically Underserved Areas. DC Breastfeeding Coalition leverages the East of the River Lactation Support Center to deliver breastfeeding support services to its target audience.

Anticipated Partnerships:

• Children's National Hospital – DCBFC plans to continue this strong partnership. Children’s provides in-kind space for the East of the River Lactation Support Center at Children’s primary care site in Anacostia. In FY23, DCBFC led a Pediatric Provider Breastfeeding Learning Collaborative for Children’s Practitioners. 
• Community of Hope – DCBFC plans to continue its partnership with Community of Hope (COH). COH is a champion of breastfeeding and prioritizes staff engagement and training, patient education and breastfeeding support, and referrals to DC Breastfeeding Coalition.
• United Planning Organization (UPO) – DCBFC plans to strengthen its partnership with this early learning and development center. UPO is eager to leverage early learning teachers to support breastfeeding families. DCBFC plans to enhance staff training, family education and breastfeeding support, referrals to DC Breastfeeding Coalition, and group breastfeeding classes.
• WIC – DCBFC plans to continue its partnership with DC WIC. DCBFC plans to work with WIC to increase referrals of participants whose needs exceed the scope of practice of the WIC breastfeeding peer counselors. DCBFC also plans to continue leveraging its IBCLC to mentor DC WIC’s IBCLC, who recently achieved certification to assist with transitioning from peer counselor to IBCLC.

In FY24, Title V will continue to support DC WIC. DC WIC’s work aligns with the Title V goals and DC Health’s Community Health Administration’s (CHA) Framework for Improving Community Health. Below are strategies that DC WIC supports.

CHA Framework:

• Maternal and Reproductive Health Services
• Care for Young Children
• Nutrition, Physical Activity, and Weight Status

 

Title V:

• Access to quality health care for mothers and children, especially for people with low incomes and/or limited availability of care;
• Health promotion efforts that seek to reduce infant mortality and the incidence of preventable diseases and to increase the number of children appropriately immunized against disease; and
• Access to comprehensive prenatal and postnatal care for women, especially low-income and/or at-risk pregnant women.

Key planned program activities for FY24 are detailed below.

• Grantee Partners – DC WIC supports four grantee providers: Children’s National Health System, Mary’s Center, Unity Health Care, and Community of Hope, to offer place-based WIC services in health care settings. Fifty-two authorized grocery stores, corner stores, pharmacies, and a commissary in the District and Maryland accepted DC WIC benefits.
• American Rescue Plan Act Waivers – DC WIC has applied for the American Rescue Plan Act (ARPA) waivers from United States Department of Agriculture (USDA) to enable the Program to continue offering remote services and benefits to participants. This is a key initiative for WIC nationwide to enhance program uptake, participation, and retention. 
• Pacify – DC WIC continues to utilize Pacify, a lactation support app, for participants to gain access to free 24/7 virtual lactation support. DC WIC plans to work with Pacify to expand the offering to all mothers across the District in upcoming years.
• Vendor Advisory Group – DC WIC will continue to host bi-annual Vendor Advisory Group meetings. The DC WIC Vendor Advisory Group serves as a communication forum between WIC-authorized retail stores, professional trade organizations, food distributors, local nonprofit organizations, the DC Food Policy Council, WIC local agencies, and the DC WIC State agency. This Group is integral in providing feedback and input as DC WIC works to improve the WIC vendor and participant experience.
• Online Ordering – DC WIC will continue identifying and applying innovative solutions to improve the participant shopping experience and increase participant retention. Of those solutions, DC WIC will focus on applying for funding to support the implementation of online ordering and home delivery of WIC foods.
• USDA Breastfeeding Curriculum – DC WIC plans to fully roll out the new USDA Breastfeeding Curriculum for all DC WIC staff and other partners in the community. This will support DC Health’s efforts to improve breastfeeding continuity of care in the District.

WIC serves pregnant and postpartum women, infants, and children up to five years old with low income (at or below 185% of the Federal Poverty Level) in the District across all Wards.

In FY24, DC WIC plans to partner with several entities to increase our capacity for referring WIC participants to necessary services in the community.

• Department of Behavioral Health (DBH)– DBH will enhance DC WIC grantees’ ability to provide up-to-date substance use and abuse resources. DBH provides prevention, intervention and treatment services and supports for children, youth and adults with mental and/or substance use disorders, including emergency psychiatric care and community-based outpatient and residential services. DBH is a key partner to help DC WIC provide appropriate referrals to resources for participants using a trauma informed approach.
• LinkU DMV (FindHelp.org) – Continue building the existing relationship to enhance DC WIC’s online referral platform through LinkU DMV, an online referral platform for community services and programs. LinkU DMV is managed by FindHelp.org, which is a leading social care network that maintains a repository of community programs and resources. FindHelp partners with DC Health to provide this DC-specific site, allowing DC WIC Local Agencies to receive referrals through LinkU.  DC WIC staff also use LinkU to make referrals and help address social needs of WIC families.
• Lactation Commission – DC WIC will continue to work with the Mayor’s Lactation Commission members to build the capacity and presence of the Commission in the community. DC WIC is a key collaborator and facilitates partnerships between multiple agencies [Office of the State Superintendent of Education (OSSE), Department of Human Resources (DCHR), Department of Health Care Finance (DHCF), Department of Human Services (DHS)] and community-based organizations to strengthen a systems approach to support breastfeeding women in the District. DC WIC supports the Commission in strategic planning, maintaining membership, and involving local stakeholders in the breastfeeding/lactation space.
• DC Hunger Solutions – DC WIC will continue to host quarterly meetings with DC Hunger Solutions. D.C. Hunger Solutions, founded in 2002 as an initiative of the Food Research & Action Center (FRAC), works to end hunger in the nation’s capital and improve the nutrition, health, economic security, and well-being of low-income District residents. DC Hunger Solutions directly supports WIC-eligible families in the District and advocates for the WIC Program.
• DC Central Kitchen – DC WIC will continue to work closely with DC Central Kitchen (DCCK). DCCK is an iconic nonprofit and social enterprise that combats hunger and poverty through job training and job creation. The organization provides hands-on culinary job training for individuals facing high barriers to employment while creating living wage jobs and bringing nutritious, dignified food where it is most needed. Leveraging DCCK and its existing relationships with small corner stores continues to be instrumental in onboarding small stores to the DC WIC Program and increasing food access in neighborhoods lacking sufficient retail food store options.

In FY24 DC WIC plans to enhance and build upon existing services and networks.

In FY24, DC Health will continue to fund the DC Healthy Start Program (DCHS), support its efforts in improving health outcomes before, during, and after pregnancy, and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes within the District of Columbia. DCHS is an instrumental partner whose target population is women, children under 18 months, and fathers/partners connected to mothers that reside in Wards 5,7 and 8. Healthy Start activities will continue addressing the needs of the reproductive-age women in the District and moving the needle of our identified Title V objectives by continuing to support wrap-around services offered in both Mary Center and Community of Hope clinics that allow for early engagement in prenatal care coupled with the clinically integrated program offerings where grantees maximize the opportunity for engagement. With both programs being clinically integrated, the care coordinators work closely with the providers to ensure adequate support and resources are provided to the patient, appointments are scheduled and rescheduled as needed, referrals are submitted to home visiting, emotional wellness, sexual health coordinators, WIC, dental services, lactation support etc. and case conferencing is completed.

In FY24, DCHS has yet to anticipate major changes planned as far as overarching program goals. However, some changes within the clinic overall may impact their work on the Title V objectives. During the last grant cycle, there was significant staff turnover. The impact of this turnover will continue to impact the work in multiple ways as follows:

• Pause enrollment into Health Start
• Continued paused enrollment hindering the program’s doulas from reaching their projected productivity as their recruitment pool is reduced.

Focus Area 2: Risk Appropriate Perinatal Care

Performance Measures:

• Continued: State Performance Measure (SPM) 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birthweight infant.

 

Objective 2: Increase percent of pregnant women who initiate prenatal care in the first trimester from 68% to 75% by 2026.

Strategies:

• Enhance capacity to provide a space for women to engage in early and continuous prenatal care to prevent maternal complications. 
• Enhance health information technology systems.
• Increase identification of women at risk for preterm delivery and offer access to effective treatment to prevent preterm birth and referral to Maternal Fetal Medicine specialists.
• Increase the identification of effective approaches for improving birth outcomes such as group prenatal care (e.g., Centering Pregnancy) that provides a space to engage the target population through health education sessions to increase knowledge to encourage positive pregnancy health outcomes.
• Improve access to preconception care services, including screening, health promotion, and interventions that enable individuals to achieve high levels of wellness, minimize risks, and enter pregnancy in optimal health.

Activities:

In FY24, Title V will continue to provide subject matter expertise guidance to the Preterm Birth Reduction Initiative in which four District birthing facilities (Community of Hope, Medstar Washington Hospital Center, Howard University and Unity Healthcare, Inc.) were selected through a formal request for the application process, to implement evidence-based strategies to reduce the occurrence of preterm birth among at-risk District residents and improve health outcomes. The awardees shall continue to implement a targeted, community-based approach to reducing preterm birth and health disparities by engaging the priority population, but not limited to Black/African American birthing persons and residents of Wards 4, 5, 7, and 8 to build relationships and leverage resources within the community utilizing the following strategies:

• Increase the identification of effective approaches for improving health outcomes with the goal of promoting the dissemination, adoption and sustainability of these approaches.
• Reduce the health disparities that occur by categories such as gender, race or ethnicity, income and education, disability, neighborhood, or sexual orientation, informed by the target populations identified by the Disparity Impact Statement.
• Improve access and utilization of health care.

• Access to preconception care services, including screening, health promotion, and interventions that enable individuals to achieve high levels of wellness, minimize risks, and enter pregnancy in optimal health, including but not limited to:
  • Increase identification of current substance use, including tobacco and marijuana use and referral to DC Quitline and counseling services.
  • Increase referral and enrollment into WIC and other nutritional services.
  • Increase referral to chronic disease self-management programs, diabetes self-management education, and nutritionists.
  • Provide education on signs and symptoms of preterm birth.
• Increase identification of women at risk for preterm delivery and offer access to effective treatment to prevent preterm birth and referral to Maternal Fetal Medicine (MFM) specialists.
• Prevention of unintended pregnancies.

 

There are several key indicators that awardees will be responsible for tracking over the course of the grant period. Data Reporting templates will be shared with all grantees and must be submitted with all monthly and quarterly, and annual progress reports. The indicators are based on DC Health’s overall strategic objectives and serve as key performance indicators to assess progress at helping to reduce maternal morbidity and mortality, including classification of high-risk women, intervention and gestational age, entry into care, social determinants of health, centering pregnancy, contraception, tobacco product use/marijuana use, and mental health.

 

In FY24 Title V program will continue to fund two Well Woman Projects: Unity Healthcare, Well Woman Project (Unity) and La Clínica del Pueblo’s Mujeres Saludables (Well-women) Project (La Clínica), which are discussed in further detail in the Women/Maternal Health Domain. Both grantees have implemented evidence-based well-woman promotion strategies to expand access to interception care, preconception care, quality prenatal care, and health care over the life course to improve equity of birth outcomes in the District. While both projects focus primarily on Well Woman interventions, they also implement strategies directly aligned with Title V’s goal of improving risk-appropriate perinatal care. Such as staff training, outreach campaigns, health fairs, and individual education sessions. They will continue to enhance the capacity to provide a space for women to engage in early and continuous prenatal care to prevent maternal complications.

 

As previously shared, the DC Healthy Start Program (DCHS) activities will continue to support wrap-around services offered in both Mary Center and Community of Hope clinics that allow for early engagement in prenatal care coupled with the clinically integrated program offerings where grantees maximize the opportunity for engagement. With both programs being clinically integrated, the care coordinators work closely with the providers to ensure adequate support and resources are provided to the patient, appointments are scheduled and rescheduled as needed, referrals are submitted to home visiting, emotional wellness, sexual health coordinators, WIC, dental services, lactation support etc. and case conferencing is completed.

In FY24, DCHS has yet to anticipate major changes planned regarding overarching program goals. However, due to significant staff turnover, some changes within the clinic overall may impact their work on the Title V objectives.

Objective 3: Reduce the infant mortality disparity ratio among non-Hispanic Black infants from 3.5 to 2.6 by 2026.

Performance Measures:

• Continued: SPM 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birthweight infant.

Strategies:  

• Provide support to newborn screening programs to assist with early diagnosis and connection to intervention services. 
• Incorporate safe sleep education into hospital discharge regulations at birthing facilities in the District. 
• Support home visiting programs, pre-term birth reduction programs, and case management for high-risk women. 
• Preconception and prenatal nutrition education to help lower the risk of congenital malformations. 
• Refer and track referral completion of infants needing additional screening and specialty follow-up. 

 

Activities:

Through Title V support, DC Health will continue to house the DC Health Safe Sleep Program (DC SSP) to educate and empower parents, caregivers and partnering agencies with information on SIDS, SUID, and safe sleep practices guided by the American Academy of Pediatrics Safe Infant Sleep Recommendations. The program will continue to work with our partner Cribs for Kids to obtain and distribute portable cribs (called Cribettes) to eligible District residents. The backbone of the DC SSP is its partners. The program will continue to maintain and support its wide-reaching and strong partner base made up of 35 organizations (including local hospitals, daycare centers, short-term family shelters, and community organizations) serving pregnant women and families in the District. Primarily using a “Train the Trainer Model”, the SSP Coordinator will continue to train and provide technical assistance to staff at partner organizations, as well as providers at childcare settings and trainings in conjunction with the Office of the State Superintendent of Education (OSSE) and Children and Family Services Agency’s Child Protective Service (CPS).

 

In FY24, the DC SSP will continue to target infants, birth to twelve months, residing in all DC Wards to ensure all neighborhoods have access to the program with a special emphasis on supporting connections to partner agencies that serve families in Wards 5, 7 8, which historically have had the highest rates of infant mortality in the District. The following are the key areas of focus for FY24:

 

• Fatherhood engagement: The DC SSP will emphasize working with partners to identify, educate and provide portable cribs to fathers. This is especially important for fathers who don’t live in the baby’s mother’s home and need not only to be educated on the dangers of unsafe sleep practices but also to have a safe place for their baby to sleep.
• Partnership Expansion: The DC SSP has a long-standing and strong group of partners reaching various entities that reach moms and families. Even so, the program continues to explore more opportunities to expand its reach. For example, a new partner DC SSP is seeking to partner with is My Sister’s Place, a domestic violence shelter in the District that will reach particularly vulnerable mothers that need extra support, like receiving safe sleep education and a safe sleeping environment for babies.
• Quality Assurance: The DC SSP will continue prioritizing ongoing quality assurance to ensure appropriate and consistent partner safe sleep training to eligible parents/caregivers, Cribette distribution and application processing. The program will begin conducting site visits again, slowed down during the peak COVID pandemic, as the program went all virtual. Internally the SSP will also be updating its Procedures and Process manuals and documents to effectively coordinate and continue to sustain the program.
• DC BABIES Bill Regulations: Additionally, once the final rulemaking for the DC BABIES hospital regulations is published, DC Health will promulgate the regulations to assist in enforcing newborn screening and discharge requirements like providing education on safe sleep education. The DC BABIES hospital regulations include procedures hospitals, and birthing facilities must follow to report on selected clinical quality measures and ensure compliance with comprehensive newborn screening and hospital discharge requirements for newborns delivered or cared for at a hospital or a birthing facility in DC.

 

In FY24, the District of Columbia’s Newborn Hearing Screening Program, also known as the DC Early Hearing Detection and Intervention (EHDI) Program, will continue to carry out existing key activities and partnerships but also work toward creating structures to implement the mandates of the BABIES Bill as follows:

• DC BABIES Bill Regulations: The DC BABIES Bill regulations include the release of newborn screening regulations, education materials, and informational sessions. The regulations will outline processes to standardize newborn screening procedures and data-sharing protocols at birthing hospitals and facilities, including hearing screening. 
• Formalizing and Establishing New Partnerships: It is also expected that a more formalized partnership will develop with the Office of the State Superintendent of Education (OSSE) through a Memorandum of Agreement (MOA) with their Early Intervention Program. This MOA will allow DC Health to have shared access to data, along with OSSE, to aid both entities in thoroughly following and tracking babies who are D/HH and qualify for EI services from the referral stage to the admission and participation stages. In addition, DC EHDI will foster new relationships with the Office of Health Equity and the Mayor’s Office of the Deaf, Deafblind, and Hard of Hearing (MODDHH).
• HRSA EHDI Grant Application: DC EHDI will submit grant applications for continued funding to support program initiatives and expand personnel. The program will identify opportunities for improvement and ways to maximize expenditures. DC EHDI will also work towards developing an enhanced infrastructure dedicated to health equity and adherence to the 1-3-6 benchmark. This project plan’s goal is to solidify foundational development for the DC EHDI program starting with obtaining accurate data elements to identify populations we serve and ensuring children diagnosed as deaf or hard of hearing (D/HH) are linked to appropriate care.
• OZ Newborn Screening Database: DC EHDI anticipates implementing Telepathy EHDI in all birthing hospitals. Telepathy EHDI is a software tool that captures results directly from screening devices and will assist in reducing missing newborn hearing screening results. DC EHDI will support birthing hospitals utilizing the new features, provide technical assistance when needed, and implement quality improvement work to track and improve utilization.
• Stakeholder Engagement: DC EHDI will continue hosting meetings for stakeholder engagement to assess EHDI systems and processes. The program will identify, recruit, and sustain external relationships among lapsed or missing EHDI stakeholders to support the inclusive representation of DC. Lastly, DC EHDI will develop targeted communications for D/HH families and community partners to assist in outreach.
• DC EHDI Family Support: DC EHDI will continue to support the Family Support and Follow-Up Coordinator position to carry out a range of activities to facilitate family-to-family and adult-to-family support services for the EHDI program and serve the families of the D/HH community in the District. Family Support will be carried out in collaboration with professionals, other families with children who are D/HH, and current, up-to-date, evidence-based information and resources. This coordinator will be responsible for prioritizing all planned family support activities/services to be led or informed by feedback from parents of children who are D/HH or D/HH adults, conducting extended follow-ups in the EHDI pathway, assisting in mobilizing community partnerships and strengthening community collaborations through linking families to appropriate services, including working together with internal and external partners supporting a variety of long-term follow-up services. DC EHDI is also exploring opportunities to expand partnerships and strengthen the capacity to provide family support and engage families with D/HH children and D/HH adults throughout the District’s EHDI care continuum.

In FY24, the DC Health Newborn Metabolic Screening (DC NMS) Program (DC NMS) will continue to ensure that all newborns born in the District of Columbia are screened for 45 inherited metabolic and genetic disorders that are treatable by diet, vitamins and/or medication or by anticipatory measures to prevent attacks by testing infants within 48-72 hours of birth for genetic and metabolic disorders prior to leaving the hospital. The program’s goal is to lessen the gap for disparities that exist in vulnerable populations by offering resources, interventions, referrals, and follow-up management to all families with abnormal screening results as follows:

• Continued DC NMS Tracking and Follow-up: DC NMS will continue to follow up on all abnormal lab results, verify infant links to a primary medical home, specialist, and/or tailored resources to meet individual needs to better ensure that newborns needing further testing are evaluated quickly, referred to specialty care and connected to appropriate care and treatment.
• DC NMS Program Staff Expansion: Near the end of FY22, the DC NMS Program hired a Program Coordinator to provide management of all DC NMS tracking systems, follow-up with birthing hospitals and other pediatric providers, and support of stakeholders and families across the District touching newborn metabolic screening. The DC NMS tracking systems maintain all of the abnormal lab screening results, follow-up information on referrals for care, updates on notifications and next steps through consultation with health providers, child-care providers and other related individuals and services. In conjunction with the Program Specialist, the Program Coordinator will lead efforts to ensure newborns receive appropriate next steps, links to care and early intervention for treatment as warranted. DC NMS will continue to be maintained successfully and expand under the direction of the Program Coordinator. 
• Tracking and Surveillance through New Data Repository: The DC NMS Program’s follow-up team facilitates the efficient communication of presumptive positives and other abnormal screening results to recommend further actions to ensure the case is resolved with the infant’s provider(s) in a timely manner. All abnormal results and follow-up activities are recorded and tracked in an internal database management system. DC NMS recently started collaborating with the national newborn screening resource center, Association of Public Health Laboratories’ Newborn Screening Technical Assistance and Evaluation Program (NewSTEPs) Program. NewSTEPs is a nationally recognized resource center aimed with technology tools to assist with creating a data repository to manage and store health care information technology. DC Health and NewSTEPs recently launched an MOA to establish a framework in which the DC NMS program will share data with the data repository for tracking and surveillance of de-identified case data and quality indicator data. The DC NMS Program is building out a process with providers providing infants with specialized care and treatment to collect data on individual confirmed cases. These efforts will provide a more streamlined approach that will allow comparisons of the prevalence of screening disorders to enhance surveillance and follow-up efforts.
• OZ Newborn Screening Database: The DC Health newborn screening database system - OZ eSP Database – currently only receives newborn hearing screening data in conjunction with the DC Early Hearing Detection and Intervention (DC EHDI) Program – will expand to integrate the Newborn Metabolic Screening (NMS) Program and the Critical Congenital Heart Disease (CCHD) Screening Program into the database to improve and streamline data collection and follow-up. By integrating all of DC’s Newborn Screening Programs into one data platform, DC NMS anticipates this integrated effort will help streamline and improve newborn screening surveillance and create a more seamless and coordinated approach for referrals, intervention, and follow-up activities.
• DC BABIES Bill Regulations: Once the final rulemaking for the DC BABIES hospital regulations is published, DC Health will promulgate the regulations to assist in enforcing newborn screening requirements like providing education on newborn screening, ensuring consistent documentation of those who don’t consent for screening, implementation of screening and data sharing with DC Health to ensure appropriate and timely tracking and follow-up takes place. The DC BABIES hospital regulations include procedures hospitals, and birthing facilities must follow to report on selected clinical quality measures and ensure compliance with comprehensive newborn screening and hospital discharge requirements for newborns delivered or cared for at a hospital or a birthing facility in DC.

In FY24, the District of Columbia Perinatal Quality Collaborative (DCPQC) will continue to work with the Clinical Implementation Workgroups to implement data-driven quality improvement. To help the hospital further their work using a rapid cycle process improvement, we plan to implement Communities of Learning (COL) focused on how to use data-driven quality improvement to improve bundle specific measures. DCPQC will continue the work in progress to expand representation of family and patient in the PQC and directly in quality improvement activities to enhance and strengthen the work. In addition, DCPQC will focus on expanding data analytics capacity through implementation of specific recommendations identified through engagement with the Urban Institute.

 

The capacity to monitor progress on improvement efforts of the Alliance for Innovation Maternal Health (AIM) measures over time to understand implementation progress and outcomes has significantly enhanced. Although progress is evident, work continues focusing on other AIM hypertension bundle measures such as timely treatment. In FY24, DCPQC plans to enhance the quality improvement technical assistance support through structured Communities of Learning (COL). The approach will leverage course components and resources to support the ongoing adoption of 2 – 4-week sprint-focused COLs based on identified needs that can be implemented quickly with the practical technical assistance needed for participants to execute on learned content within the sprint. This COL structure will include developing targeted tools and resources, coaching, and a standardized meeting and reporting process to allow members to learn how to implement change and track progress more rapidly. Based on the DCPQC’s experience with a structured COL through AIM and a pilot COL on Quality Improvement methodology conducted in 2023 by our PQC, DCPQC will include teach-back methods and assignments throughout the course of the COL to prompt hospital teams to think critically about the shared information and report clearly on progress and barriers.

 

Patient and family representatives will be more integrally included in the communities of learning. These individuals will work directly with hospital improvement teams as equal members to inform and develop protocols and pilot changes designed to improve the quality of care, patient experiences, and clinical outcomes. Lessons learned and a plan identified through a national COL along with input directly from participating patients and family members, will be leveraged to develop plans for the DCPQC to turn thought into action supporting positive, connected engagement. Additional support through national programs such as Momma’s Voices will also be provided to patient and family representatives to help them engage effectively with providers on quality improvement and provide feedback on ideas and materials.

Innovative approaches to improving the timeliness and quality of data are necessary to support the success of DCPQC efforts and provide capacity to expand the scope of the DCPQC. The DCPQC identified a need to gather and improve data from existing sources such as improving the hospital discharge data, connecting to Medicaid data and expanding our partnership with the CRISP Health Information Exchange to support more rapid process improvement methods for bundle implementation and a better view into disparities and trends across the continuum. As such, the DCPQC will need to work with hospitals and other external organizations that may source data to implement regular, timely data feeds to the secure Data Science Virtual Machine (DSVM) and analytics platform maintained to support analytics. Both existing data and any expanded data sets will be used to create DC-specific reports and dashboards to ensure relevant, timely data is available to support DCPQC improvement efforts.

The target population includes mothers and expecting mothers seeking care in the District of Columbia, with a particular focus on non-Hispanic, black women from Wards 7 and 8. Local data indicate racial, ethnic, and geographic disparities in maternal health outcomes. The pregnancy-related mortality rate in the District is 44 per 100,000 in contrast to 28.4 nationwide.[1] The overwhelming majority (95%) of the District's Wards 7 and 8 residents are Black, and 70% of pregnancy-associated deaths occur in these Wards. In contrast, there were no pregnancy-related deaths in Wards 2 and 3, which are predominantly White. In addition, blacks give birth to roughly half of the babies born in the District but account for 90% of all pregnancy-related deaths and 93% of all pregnancy-associated, non-related deaths.[2]

 

The DCPQC intends to continue the established partnerships with AIM, the National Network of Perinatal Quality Collaboratives, the Developing Families Center, the CRISP HIE and the March of Dimes along with the DC-based providers and community organizations that participate directly in the DCPQC.

 

The DCPQC will continue implementing the severe hypertension in the pregnancy bundle within the five birthing hospitals until the hospitals have improved the key bundle measures. Based on approaches used by other state-based PQCs, the DCPQC will transition the hypertension bundle to a “light” version allowing hospitals to monitor key metrics to ensure sustained improvement and address any trailing improvement needs as a new bundle is selected. The new bundle will be chosen using the same methodology used for initial selection using a data-driven method.

As previously shared, in FY24, Title V will continue to provide subject matter expertise guidance to the Preterm Birth Reduction Initiative in which four District birthing facilities (Community of Hope, Medstar Washington Hospital Center, Howard University and Unity Healthcare, Inc.) were selected through a formal request for the application process, to implement evidence-based strategies to reduce the occurrence of preterm birth among at-risk District residents and improve health outcomes. The awardees shall continue to implement a targeted, community-based approach to reducing preterm birth and health disparities, directly affecting infant mortality, by engaging the priority population, but not limited to Black/African American birthing persons and residents of Wards 4, 5, 7, and 8 to build relationships and leverage resources within the community.

As previously shared, the DC Healthy Start Program (DCHS) activities will continue to support wrap-around services offered in both Mary Center and Community of Hope clinics that allow for early engagement in prenatal care coupled with the clinically integrated program offerings where grantees maximize the opportunity for engagement. With both programs being clinically integrated, the care coordinators work closely with the providers to ensure adequate support and resources are provided to the patient, appointments are scheduled and rescheduled as needed, referrals are submitted to home visiting, emotional wellness, sexual health coordinators, WIC, dental services, lactation support etc. and case conferencing is completed.

In FY24, DCHS has yet to anticipate major changes planned regarding overarching program goals. However, due to significant staff turnover, some changes within the clinic overall may impact their work on the Title V objectives. Both Mary’s Center and Community of Hope commit to maintaining transparent communication with the DC Health Healthy Start team regarding strategic responses to fluctuating staff capacity. Meanwhile, the DC Health team will consider resources and partnerships that could supplement grantee staff capacity.

Objective 4: Decrease the percentage of low-birth weight infants with Medicaid Insurance from 60% to 40% by 2025

Performance Measures:

• Continued: SPM 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birth weight infant.

 

Strategies:

• Enhance the capacity to provide a space for women to engage in early and continuous prenatal care to prevent maternal complications. 
• Enhance health information technology systems.
• Increase identification of women at risk for preterm delivery and offer access to effective treatment to prevent preterm birth and referral to Maternal Fetal Medicine specialists.
• Increase the identification of effective approaches for improving birth outcomes, such as group prenatal care (e.g., Centering Pregnancy) that provides a space to engage the target population through health education sessions to increase knowledge to encourage positive pregnancy health outcomes.
• Improve access to preconception care services, including screening, health promotion, and interventions that enable individuals to achieve high levels of wellness, minimize risks, and enter pregnancy in optimal health.
• Increase prenatal care within the first trimester

Activities:

Preterm Birth Initiative As previously shared, in FY24, Title V will continue to provide subject matter expertise guidance to the Preterm Birth Reduction Initiative in which four District birthing facilities (Community of Hope, Medstar Washington Hospital Center, Howard University and Unity Healthcare, Inc.) were selected through a formal request for the application process, to implement evidence-based strategies to reduce the occurrence of preterm birth among at-risk District residents and improve health outcomes. The awardees shall continue to implement a targeted, community-based approach to reducing preterm birth and health disparities, directly affecting infant mortality, by engaging the priority population, but not limited to Black/African American birthing persons and residents of Wards 4, 5, 7, and 8 to build relationships and leverage resources within the community utilizing the following strategies:

• Increase the identification of effective approaches for improving health outcomes with the goal of promoting the dissemination, adoption and sustainability of these approaches. 
• Reduce the disparities in health that occur by categories such as gender, race or ethnicity, income and education, disability, neighborhood, or sexual orientation, informed by the target populations identified by the Disparity Impact Statement.
• Improve access and utilization of health care.

• Access to preconception care services, including screening, health promotion, and interventions that enable individuals to achieve high levels of wellness, minimize risks, and enter pregnancy in optimal health, including but not limited to:
  • Increase identification of current substance use, including tobacco and marijuana use and referral to DC Quitline and counseling services
  • Increase referral and enrollment into WIC and other nutritional services
  • Increase referral to chronic disease self-management programs, diabetes self-management education, and nutritionists
  • Provide education on signs and symptoms of preterm birth
• Increase identification of women at risk for preterm delivery and offer access to effective treatment to prevent preterm birth and referral to Maternal Fetal Medicine (MFM) specialists.
• Prevention of unintended pregnancies.

As previously shared, the DC Healthy Start Program (DCHS) activities will continue to support services offered in both Mary Center and Community of Hope clinics that allow for early engagement in prenatal care coupled with the clinically integrated program offerings where grantees maximize the opportunity for engagement. With both programs being clinically integrated, the care coordinators work closely with the providers to ensure adequate support and resources are provided to the patient, appointments are scheduled and rescheduled as needed, referrals are submitted to home visiting, emotional wellness, sexual health coordinators, WIC, dental services, lactation support etc. and case conferencing is completed.

In FY24, DCHS has no anticipated major changes planned regarding overarching program goals. However, due to significant staff turnover, some changes within the clinic overall may impact their work on the Title V objectives. Both Mary’s Center and Community of Hope commit to maintaining transparent communication with the DC Health Healthy Start team regarding strategic response to fluctuating staff capacity. Meanwhile, the DC Health team will consider resources and partnerships that could supplement grantee staff capacity.

 

 

[1] District of Columbia Maternal Mortality Review Committee. 2019-2020 Annual Report. Accessed at https://ocme.dc.gov/sites/default/files/dc/sites/ocme/agency_content/Maternal%20Mortality%20Review%20Committee%20Annual%20Report_Finalv2.pdf on April 18, 2023

[2] 2014-2018 Natality and Mortality Files; Vital Records Division, Center for Policy Planning and Evaluation, DC Department of Health.