Friendly Access: A Tool FIMRs Can Use
Suzanne F. Morrow, MS; Jennifer Gornto, MPH; Carol M. Brady, MA
JACKSONVILLE
The Lawton and rhea chiles center For Healthy Mothers And Babies
ACCESS
FRIENDLY
SM
Background:
Jacksonville/Duval County has one of Florida’s highest infant mortality rates. Late or no prenatal care has been identified as a contributing factor in infant deaths reviewed by FIMR (Fetal and Infant Mortality Review). These reviews have indicated that obtaining or using prenatal care is especially problematic for Blacks. Problems were cited in almost half (48%) of the black cases compared to 26% for white.
Infant Mortality Rates 2003
16 14 12 10 8 6 4 2 0 County State White Black 9.8 7.1 6.4 14.9
Survey Results – Critical Issues Identified
1. Lack of understanding about Medicaid 2. Long wait times 3. Poor care coordination 4. Negative relationships between patients and providers 5. Lack of education 6. Inadequate transportation
Fair
Survey Results – Supporting Data
5 out of 5 focus groups indicated problems with getting and using Medicaid 60% of prenatal respondents did not think that the wait time in the waiting room was “excellent” 76% said the provider did not help in finding a pediatrician for the newborn baby 59% of the prenatal respondents did not think that the concern shown by receptionists and nurses was “excellent” 47% of the pediatric respondents said the office staff is not “always” as helpful as they should be 48% of the prenatal respondents and 33% of the pediatric respondents did not have a high school diploma or GED 5 out 5 focus groups identified lack of reliable transportation as a problem
Duval County
5%
Poor 1%
Strategy:
The Northeast Florida Healthy Start Coalition and its community partners applied to SM participate in the new National Friendly Access Initiative, sponsored by the Lawton and Rhea Chiles Center at the University of South Florida. One of four implementation sites, the SM Jacksonville Friendly Access Initiative aims to increase use of prenatal and infant care through improving customer satisfaction by working with consumers to identify and resolve of barriers to care.
How Would You Rate the Concern Shown by the Good Receptionists 30% and Nurses? Very
Good 23%
Excellent
41%
Recommended Strategies
Fair 3% Poor 0%
National Program Model
WE ARE HERE
Phase I
Creation of teams Baseline assessment
Phase II
Disney –learn methods to improve customer satisfaction
Phase III
Strategic Planning
Phase IV
Service Quality is Improved
Phase V
Customers Feel Quality is Improved
Phase VI
Customers Use Services More
Improved health for moms & babies
How Would You Rate the Respect the Provider Showed Toward You?
Good 28%
Excellent 49%
Very Good 20%
1. Provide education to providers and consumers on how to access and use Medicaid. 2. Coordinate appointment times with the provider and others who must also see the patient. 3. Require health care personnel to provide client-centered care SM by following the Friendly Access Service Standards and Guidelines. 4. Provide patients with educational materials on their health and their children's health. 5. Work with the county transportation system to provide better transportation to Medicaid recipients and their families.
Conclusions: Survey Methodology:
345 women interviewed in the hospital at Shands after delivery 375 parents of children age 0 to 5 interviewed in the pediatric clinic 220 item survey assessing satisfaction with care, access and barriers to care, facility characteristics, care content, and health status 5 focus groups with women who had received prenatal care at target clinics Consumers of prenatal and pediatric care do face significant barriers. Involving consumers in the planning of effective interventions to reduce barriers to care is an effective strategy and can have an impact on future health outcomes.
Partners:
Project Moses: Churches Work to Address SIDS and Sleep-Related Deaths
Karen Smithson, Coordinator, Hold-Out the Lifeline, The East Florida Conference African Methodist Episcopal (AME) Church Ministerial Alliance, Inc. & Carol Brady, MA, Executive Director, Northeast Florida Healthy Start Coalition, Inc.
Problem:
In Jacksonville and other areas, Sudden Infant Death Syndrome (SIDS), accidental overlays and related conditions are the leading cause of infant mortality after the first month of life. Black babies account for nearly 50% of sleep-related deaths in northeast Florida. Nearly 80% of these deaths occur to babies who were bed sharing or in an inappropriate bed.
Sleeping Infant Death Rates, Jacksonville 2000-2003
2.00 1.89 1.80 1.63
Sleeping Infant Deaths, Identified Risk Factors, Jacksonville 2003
90% 79% 71% 70% 80%
Project Moses provides education to the new families and the community about risk factors associated with SIDS and other sleep-related deaths. Each bassinet includes information about the importance of a safe sleeping environment, reducing the risk of SIDS, and related material. Information on SIDS, risk factors, appropriate sleep position and sleep environment is also distributed to church volunteers who will construct the bassinets.
1.60 1.40 1.40
1.37 1.31
Percent of Deaths with Risk Factor
FIMR Community Action Team
57%
Deaths/1000 Live Births
60%
1.20 1.08 1.00 0.82 0.80
1.21
1.13 1.08
Project Moses - Survey, 2002 / N=124
Would you put your baby in this basket to sleep for the night or to nap in during the day? Yes 90% No 10% Do you think this basket is safe enough for your baby to sleep in? Yes 90% No 10% Would you use this basket for your baby if it were free? Yes 90% No 10% Did you know more Black babies die before their first birthday than other babies do? Yes 38% No 62%
50%
0.83 0.68
40% 29%
0.60
30%
Total White
0.40
Black
20%
0.20
10%
0.00 2000 2001 2002 2003 Source: Northeast Florida Healthy Start Coalition, Inc. Project Impact (FIMR) record reviews, 2004.
0% Second Hand Smoke Sleep Position (Other Than Back) Co-sleeping Inappropriate bedding
Recommendation: Action:
Source: Northeast Florida Healthy Start Coalition, Inc. Project Impact (FIMR) record reviews, 2004.
Implement a faith-based awareness and education campaign to promote safe sleeping in the black community.
The FIMR Community Action Team undertook initial planning for Project Moses. Members conducted surveys of pregnant women to determine demand for the bassinet. They also constructed a prototype based on a similar project in Fort Myers. Once planned, Hold-Out the Lifeline and the AME Ministerial Alliance, implemented the project. Project Moses works with member churches of the AME Ministerial Alliance to make and distribute special bassinets which are distributed to new families through hospitals and social services agencies.
Outcomes:
The goal of Hold-Out the Lifeline is to distribute 500 bassinets over the next year. About 250 bassinets have already been constructed and distributed by the project which is funded by the Florida Department of Health through its “Closing the Gap” initiative. Project Moses has received TV news coverage, further raising community awareness about SIDS and sleep-related deaths. It has generated in-kind support and donations from the community. This project can be implemented in any community!
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Cooking Among Sisters
Janice Hawkins, BS, The Magnolia Project / Tamer Briton, BS, Duval County Agricultural Extension Service Peggy Ford, BS, Duval County WIC & Nutrition Services
Serves 100 Families To Prepare:
1. Identify Need:
Poor maternal health was a contributing factor in nearly 75 percent of cases reviewed by the FIMR project in Jacksonville, Florida during 2000-03. Nutritional issues, particularly obesity, is a key factor affecting birth outcomes.
Ingredients:
1- Magnolia Project Community Council 1- Magnolia Community Development Director 1- Staff from Duval County Cooperative Extension Service A Pinch of funding from the Area Health Education Network 1- Staff from WIC & Nutrition Services 1- Exercise instructor 4- Housing Communities Sites
the project was a collaborative effort by the Magnolia Project Community Council, the Duval County WIC Program and the Duval County Cooperative Extension Service. The program organized cooking classes, exercise programs and other activities at community housing projects. Participants received copies of the “Slim Down Sister” cookbook and the “Soul Food Pyramid.” Extension Service staff demonstrated meal preparation using commodities and other available foods. Children sampled healthy snacks using fresh fruit and vegetables. The culminating activity was a field trip to a local grocery store, with tips on food shopping and understanding food labels.
2. Develop Recommendation:
Implement a neighborhood-based intervention to promote healthy weight in women of childbearing age, as well as improved nutrition and exercise.
3. Take Action!
Cooking Among Sisters, a unique neighborhood nutrition initiative, was implemented by the Magnolia Project, a federal Healthy Start program, in 2002. Funded by the Northeast Florida Area Health Education Center,
4. Outcome:
More than 100 women and their families took part in Cooking Among Sister activities. A community cookbook was also published as part of the project, featuring recipes from Community Council members, Magnolia Project staff and neighborhood residents.
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The Magnolia Project
Enjoy this project in your community!
: A Project Management System for FIMR
Laurie Lee, RN, BSN; Allan Stamm; and Carol Brady, MA Northeast Florida Healthy Start Coalition, Inc. & GBP Technologies, Inc.
Problem/Issue
Manual collection, tracking and trending of FIMRrelated information consumes limited project resources. Current data management systems are cumbersome. Volumes of paper and inconsistencies in how information collected by the various Florida projects limits the usefulness of FIMR findings at both the community and state level. (Findings: Contributing Factors)
Recommendation
Create a project management system that would improve the quality and consistency of local FIMR reports, including case selection and abstraction, record requests, review team findings, required state reports, as well as the collection and analysis of current vital statistics data.
(Mom's Medical History)
Action
Modify, refine and expand a basic Access minimum data set provided by the state into a user-friendly, web-based system in an SQL platform that can be used by FIMR projects statewide. Expand the database into a comprehensive project management system. Funding for this effort was provided by the Florida Association of Healthy Start Coalitions, Inc. Basinet (Baby Abstraction System & Information NETwork) is born! (Socioeconomic Info)
(Canned and Custom Reports/Graphs)
(Mom's Pregnancy A-Z)
(OB history/Family Planning)
(Baby's Story)
Impact
BASINET streamlines FIMR abstraction, data collection and reporting processes, and improves quality of data surveillance.
(Smart Search Options) (Case Record Main Page) Basinet features a secure, confidential system (128 bit encryption, limited levels of access) with point and click functionality. It offers auto-fill and auto-calc fields. Expanded number of fields enables comprehensive summary and review. Basinet includes built-in reports for review team, funders. FIMR Projects will receive BASINET training in November with statewide launch in January, 2005.
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