Georgia Partnership Uses Telemedicine and Centering Pregnancy Model to Significantly Decrease Preterm Labor Birth Rate in High Risk Areas
Southwest Health District’s CenteringPregnancy® program and Women’s Telehealth in Atlanta have teamed up to deliver effective, efficient, high-quality access to prenatal care that significantly improves health outcomes among African Americans and Hispanics in an underserved corner of Georgia. Following the launch of the first-of-its-kind partnership between group prenatal care and maternal-fetal telemedicine, the percentage of pre-term deliveries and low birth-weight babies continues to be well below baseline rates in target populations.
The model is transferable to other areas that lack sufficient OB providers, and can greatly enhance care by providing maternal fetal monitoring and consulting to patients who otherwise lack access to such special services, say the principals behind the partnership. Both principals – Southwest Health District Health Director Dr. Jacqueline Grant, an obstetrician, and Women's Telehealth founder Dr. Anne Patterson, a maternal fetal medicine specialists – use alternative practice models to improve women's access to prenatal care.
Southwest Health District's program is the first Centering program in the nation to include telemedicine, said Program Manager VaLenia Milling. It is also the first accredited Public Health-based Centering program in Georgia. The district received a March of Dimes grant to implement the Centering program in 2009 to combat a glaring healthcare disparity gap and access to healthcare issues in the predominantly rural 14-county Southwest Health District. The program remains funded through grant sources today.
The Centering program initially focused on low-income African-American birth outcomes in Dougherty County, Milling said. In 2011, it expanded into Colquitt County's Ellenton Clinic, where it began addressing prenatal care needs of often undocumented low-income Hispanic farm worker women.
CenteringPregnancy® is a national model of group prenatal care with groups of women whose due dates are in the same month," Milling said. "The groups meet for individual assessments and facilitated discussions in nine two-hour sessions monthly until 28 weeks gestation, then every two weeks until 36 weeks gestation. Afterwards we partner with private practices who continue to provide care through delivery."
When the group "circles up" for their monthly group meeting, Dr. Patterson periodically participates on-camera from her office in Atlanta. "We start with discussing antenatal testing," she said. "On subsequent visits, we educate patients on fetal growth, gestational diabetes and potential complications such as hypertension and preterm labor. If they have no problems, then they only see me those times. But if they do develop a high risk problem requiring intervention, they already know me. They are comfortable having a consultation and I think this format also promotes improved compliance."
The arrangement is much more efficient and effective for low-income patients who must make childcare or travel arrangements, or who lack convenient access to telephones, Milling said. "It also eliminates barriers of insurance status for the patients, so we are seeing them earlier," added Dr. Grant. "There is also an ease of scheduling. Patients are consulting earlier and are more compliant."
The public-private partnership serves the patients well. The baseline (2004-2008) African-American preterm birth rate for Southwest Health District is 18.2%. The Dougherty site (the county has an 86% African-American population) is 8.1%. Preterm birthrates in the Ellenton Clinic in Colquitt (100% Hispanic population served) reflect similar promise. Centering rates of 6.7% there compare favorably to the baseline Hispanic district rate of 12.1%.
"The success of this pilot is evidence the model can be replicated in other areas with high-risk populations,” Dr. Patterson said.
The program's efforts are part of an overarching initiative using telemedicine to reach Georgia’s 159 counties, with hopes of bringing specialized care to underserved areas of Georgia, saving time and money for patients, providers and public health staff,” says Suleima Salgado, director of Telehealth and Telemedicine for the Georgia Department of Public Health.
Southwest Health District Centering Contact: VaLenia Milling 229-430-6332. Women’s Telehealth Contact: Tanya Mack 404-702-2055