Improving the Quality of Perinatal Care
            Enhancing the Delivery of State-of-the-Art Care

Few areas of medicine have as much potential as those focused on improving the delivery of care. In the U.S., it takes an estimated 17 years for proven methods of care to be integrated into routine patient care. The Institute of Medicine refers to this gap as the “quality chasm”—the gulf between what healthcare professionals know is high-quality care and the care that patients actually receive. To bridge these gaps and promote quality perinatal care, LA Best Babies Network created the Healthy Births Care Quality Collaborative in 2006 with the National Initiative for Children’s Healthcare Quality as its partner.

The Care Quality Collaborative has one main focus: the patient. To solve patient problems, participants build teams rather than try to operate independently. They rely on evidence-based scientific research. They respect and honor the patient and her cultural beliefs. They track their care through a Web-based client registry that records everything from tests for depression to obesity to infections. They know that providing the

Improving pregnancy and birth outcomes means significantly altering the way prenatal care is delivered and managed. In 2006-2007, LA Best Babies Network successfully enlisted 10 outstanding clinical sites staffed by more than 50 clinicians and administrators throughout L.A. County to participate in the Care Quality Collaborative. These clinics are already weaving well-tested strategies into their daily routines to improve prenatal and postpartum care. Network staff created a comprehensive model of care that addresses the fragmented nature of office systems. Participating clinics embraced this model, as well as the challenging goals of the collaborative: to reduce preterm births by 20 percent, increase breastfeeding by 50 percent and raise postpartum care by 50 percent above the baseline. They dedicated themselves to forming partnerships with community-based organizations to fill the gaps in services needed for clients and to improve systems of care. Working as a team, the clinics and organizations learned from one another’s experiences. They adopted successful strategies and learned from each other’s pitfalls

Changing Routines
One of the keys to success so far has been the ability of the collaborative’s leaders and participants to recognize the value of stepping out of their often comfortable roles and working together toward a common goal. “As humans, we tend to resist change,” says Janice French, CNM, MS, director of programs for LA Best Babies Network. She adds that it is natural to hear negative predictions from people when the goals are first presented. “So you take baby steps and start with a very small change. Once you see it wasn’t as bad as you thought it would be, it tends to cut down on resistance.”

The collaborative emphasizes a well-tested organizational method that relies on planning, testing, studying the issue and then acting on it. It allows people to make incremental shifts in procedures rather than an overhaul. Taking these small steps would not be possible without the support of each health agency’s leadership. The directors of the participating healthcare systems regularly participate in monthly

To deliver the best, most up-to-date clinical care, LA Best Babies Network also routinely provides the necessary research directly to the providers when and where they need it. With the help of the leaders of the Care Quality Collaborative, doctors and clinic staff are testing and treating pregnant women based on the most current scientific evidence. Experts say that prenatal care is often more complex than many other specialties because there are many medical and environmental components to
track. Providers must know about nutrition and psychosocial changes, housing and poverty, as well as changes to the body.

Knowing How to Communicate: Culturally and Linguistically Appropriate Care
Having up-to-date knowledge matters less, however, if providers can’t communicate the information effectively to the patient and her family. Including the woman in the decision-making process is at the heart of the collaborative’s work. Clinic staff work with each woman to set goals and plan care based on her individual needs. They also work to keep educational and community resource materials up to date and organized.

The clinics also have long been committed to another core tenet of the Network’s mission— providing comprehensive, culturally sensitive and linguistically appropriate perinatal care. Years ago, clinics recognized the need to address the diversity of the community they serve, not just in terms of race but also ethnicity, language, sexual orientation, religious beliefs and disability. Studies over the years have shown that certain racial

Theresa Nitescu, MS, RD, chief operations officer at Northeast Valley Health Corp. says that one of her case managers was stopped by one of her prenatal patients recently after a thorough intake examination. “She said she appreciated that we were even asking her all these questions,” says Nitescu, whose agency served 1,700 prenatal patients last year. “That was nice to hear and a reminder that patients really do care about these things.”

Recording Progress: the Healthy Births Database
Serving patients well means more than just having excellent and current medical information about risks or illnesses and effectively communicating that information.

Quality care also means knowing relevant details about each pregnant woman. The Healthy Births Database, an Internet-based registry, allows the members of the collaborative to input clinically useful data in a timely way. They use the data to generate reports and to plan and follow patient care. Clinics also use the database to track their progress toward providing recommended screening and treatment for all women.

The collaborative is looking forward to continuing this progress toward tracking clinical practices and care for mothers from well before pregnancy to after their child is born. There are now as many as five new sites that are interested in participating, a promising sign. “We’re empowering providers so they can improve the healthcare system,” says French. “Our vision is to create a level playing field for pregnant women so they can get the best possible care regardless of where they live and how they access care.”