West Virginia Perinatal Partnership

More About the West Virginia
Perinatal Health Partnership

The Perinatal Partnership is a model project to improve birth outcomes through a collaboration of health sciences centers, state agencies, professional associations, private medical providers, and civic groups. The project, funded by the Claude Worthington Benedum Foundation since 2006, is coordinated by WV Community Voices.

During 2006, the Partnership conducted studies to identify the problems associated with poor birth outcomes in West Virginia and identified ten primary areas needing attention. In 2007, the Partnership issued a series of reports and recommendations in the Blueprint to Improve West Virginia Perinatal Health, issued an action plan, and began implementing the work plan through a series of committees. Accomplishments since 2007 include the following:

1. Established a Statewide Perinatal System

• Identified and published guidelines for obstetrical and neonatal practices and developed educational programs to promote their use by perinatal providers.
• Worked to identify a uniform prenatal risk assessment tool and supported legislation that called for its use in West Virginia. The legislation passed in 2009. Maternal, Child, and Family Health has implemented the tool throughout WV as of December 2010.
• Identified recommendations to improve the system for perinatal transport, engaged the WV Emergency Medical System office, and began plans to establish a “One Call” system and Bed Board for hospitals. STEMS plans to initiate the one call system effective January 2011.
• Demonstrated consultation via telemedicine between community perinatal providers and specialists at a tertiary hospital. Partnered with CAMC Research Institute and the WV Telehealth Alliance to identify the needs of maternity hospitals for broadband width and equipment.
• In collaboration with CAMC, received funding from USDA and to develop perinatal telecommunication “Connect to Care” network for rural hospitals and prenatal clinics. Eighteen hospitals and rural health sites partnered with Connect to Care. Due to problems identifying all the “matching funds” from hospitals and clinics, equipment purchases delayed slightly and will be installed after the first of January 2011.
• Studied the adequacy of Neonatal Intensive Care Unit (NICU) beds and made a recommendation to the WV Health Care Authority to allow bed increases and to keep WV babies needing NICU care, close to home. NICU bed increases were gained by WVU and Cabell-Huntington hospitals.
• Established the Hospital Self Assessment Initiative to engage birthing hospitals in meeting national guidelines for personnel, training, and equipment. Nineteen WV hospitals have completed the self-assessment. Self Assessment Review Teams are conducting on site reviews and offering consultation with hospital that completed the self-assessment.

2. Identified and Address Obstetrical Provider Shortage Areas

• Identified rural areas where access to maternity care is seriously limited and designed a model rural maternity service that makes economic and social sense for underserved areas. WV Primary Care Association encouraged development of these services through community health centers.
• Identified financial aid programs that are available to nurses interested in becoming certified nurse midwives (CNMs).
• Worked with the WV Hospital Association to identify CNM credentialing best practices.
• Worked with Marshall University School of Nursing to establish a joint MSN/CNM degree program through partnership with Shenandoah University in Virginia, which will begin this year.
• Identified educational loan arrangements available to nurses for their CNM education occurring in State.
• Collaborated with Shenandoah University Midwifery Program in development of a grant to design and offer an “emergency maternity education program” for mid level practitioner’s to train emergency medical personnel and other community members. Grant received and as of 12/2010 a team is working to design the education program.
• Updated the 2006 provider study and developed a white paper identifying maternity provider numbers, geographic location, and credentials.

3. Addressed the Lack of Oral Health Care during Pregnancy

• Identified data to set benchmarks and measure changes in use of oral health care by pregnant women covered by Medicaid and partnered with “Right from the Start” program to increase oral health care among pregnant women.
• Partnered with WVU Department of Pediatrics and WV Birth Score program to issue a report on oral health among all pregnant women in the state.

4. Identified Costly Medical Procedures Associated with Poor Birth Outcomes

• Studied the frequency of labor induction among first-time mothers,both in cases with and without preexisting medical complications.
• Collaborated with the WV Health Care Authority and the March of Dimes to conduct the Obstetrical Collaborative Quality Initiative to reduce elective deliveries prior to 39 weeks gestation. Elective deliveries decreased from 21.8% of births to 8.3% of births from January through August of 2009. Fifteen WV hospitals participated.
• Studied the incidence of infants born addicted to drugs or alcohol and the associated cost of care in the NICU. The studies were released at the Perinatal Summit in 2008. Identified the frequency of C-section among first-time mothers after elective labor induction. Began work with WV HCA and March of Dimes and OB QI team to reduce c-sections to first time mothers during 2011.

5. Developed an Approach to Identify and Treat Drug Use During Pregnancy

• Researched WV Health Care Authority data to attempt to identify the extent of substance abuse by pregnant women in West Virginia and issued report.
• Conducted medical and legal research to clarify the issues and drafted a policy position paper.
• Obtained additional funds for committee work from WV Health Care Authority.
• CAMC put into place a medical service for addicted pregnant women.
• Drafted and issued Guidelines to Identify Drug/Alcohol Use during Pregnancy and Refer for Treatment and developed an educational program for medical and nursing providers.
• Issued Tool Kit to identify addicted newborns.
• Collaborated on the umbilical cord tissue study with 8 WV hospitals participating and identified 19% use of drugs/alcohol by pregnant women.
• During 2010-11 will collaborate with WVDHHR Mental Health Division, SBERT Program to take training to community health center medical professionals on how to screen and refer addicted pregnant women and get them into treatment.
• Serving on the Statewide Control Substance Abuse Panel.

6. Encouraged the Development of Perinatal Worksite Wellness Programs

• This project did not see much success in the first three years (2006-2009). After that, the WV Breastfeeding Alliance began working with worksites and progress has occurred.
• Five worksites put into place the March of Dimes Healthy Baby program for employees. Twenty-one worksites have been recognized by the WV Breastfeeding Alliance for worksite improvements to support employees who breastfeed.

7. Promote and Support Breastfeeding

• Supported the Legislature in its deliberations to establish that breastfeeding is not an act of public indecency. The legislation passed in 2007.
• Obtained $20,000 in FY 07 and 08 through efforts of the Legislative Oversight Committee on Health and Human Resources to provide hospital obstetrical nurses and others training in lactation consultation. Over 70 health care professionals completed a 45 hour Certified Lactation Specialist training course in November 2007, an additional 51 received the training in May 2009 and 50 others completed the training in December 2010.
• Promoted the establishment and development of the WV Breastfeeding Alliance (WVBA) to work in collaboration with others to promote, protect and educate the community about breastfeeding. WVBA has received $16,000 in grant funds from WVDHHR/Office of Healthy Lifestyles to award in mini-grants to: support worksites in better accommodating breastfeeding employees; and to provide support to local breastfeeding coalitions for coalition development and expansion.
• Supporting the WV Breastfeeding Alliance legislation on Mothers Right To Nurse bill during 2011.

8. Support Expanded Testing of Newborns

• Supported expansion of testing in newborns to cover all 29 potential metabolic conditions. Legislation passed in 2007 and testing began in January of 2009.

9. Promote creation of the WV Maternity Mortality Review Team

• Called for legislation to establish the routine examination of maternal mortality in West Virginia. The legislation passed in 2008, the Team was appointed and met in 2010 and has reviewed deaths. Reports will be available in 2011 after adequate data is reviewed and personal identify is protected.

10. Studied the incidence of pregnancy among WV teensand developed policy recommendations to improve the situation.*

• Commissioned the study of unplanned pregnancy in WV and submitted reports to the State Legislature in response to HCR 53 to promote the education of youth regarding how to have a healthy pregnancy.
• Provided testimony to the State legislature regarding HCR # 104 and 105 to promote the coverage of dependants for contraception and for pregnancy.
• Worked with HAPI and Partners In Community Outreach to implement an educational program to space pregnancies by 24 months. Continuing the educational project for spacing pregnancy by 24 months. Establishing measures to identify progress.
• Obtained a 2010-11 grant from the National Campaign to Prevent Teen and Unplanned Pregnancy.
• Working with WV HEPC and Southern and Parkersburg campuses for Community and Technical Colleges to reduce dropout rates connected with unplanned pregnancy. Student survey designed and conducted. Will be conducted again in April 2011 in Southern and in Parkersburg. Materials being selected to include in “Orientation to Community and Technical College” for new students. Billboards and other materials being designed.
• Supported legislation to require insurance coverage for dependents for both pregnancy and contraceptives in 2010 and will continue to support.

11. Studied the incidence of births to single WV women (up 35% since 1980).

12. Commissioned the review of the WV Medicaid Family PlanningNeedsand developed a policy recommendation regarding the waiver.

• Waiver no longer required as of 2010. Pursuing state plan amendment to increase family planning coverage for Medicaid covered women to 24 months post partum.

13. Currently collaborating with the Coalition for a Tobacco-Free West Virginia, WVDHHR/Division of Tobacco Prevention and the WVDHHR/Right from the Start Program

• The purpose of the collaboration is to support programs and policies that curb the use of tobacco during pregnancy by pregnant women and others in the home. March of Dimes Community Grants are being used to fund 2 projects in 2010 and 2011 related to smoking cessation in pregnant women, Project funded are Community Connections, McDowell County and WVU Research Corporation.

14. Established the WV Perinatal Outreach Education Projectin 2009

• The purpose was to bring up to date educational opportunities to perinatal providers and to share knowledge and expertise across the State. American College of Obstetricians and Gynecologist (ACOG) and the American Association of Pediatrics (AAP) standards emphasize the importance of outreach education that supports and allows for communication and consultation between tertiary care centers to community hospitals.
• Surveyed hospitals concerning their educational needs. Identified the following
  • STABLE (Sugar, Temperature, Assisted Breathing, Blood Pressure, Lab Work, and Emotional Support to Family).
  • ALSO(Advanced Life Support in Obstetrics)
  • EFM (Electronic Fetal Monitoring)
  • Common topics in perinatal care
  • Less common topics in perinatal care
  • Maternal and Infant transports
  • Lactation
  • NRP (Neonatal Resuscitation Program)
• Identify skilled professionals to offer educational topics and to assist them in obtaining CEU and MEU designations for the topics they will teach.
• Prepared materials to inform perinatal professionals across the State of the availability of CEU educational opportunities. Prepared a web page of information about CEU opportunities scheduled and topics offered. Scheduled and managed the offering of CEU educational opportunities in at 15 community sites across the State. Prepared, collected, and reported on evaluations of the CEU educational offerings.
• Will conduct another survey in 2011 to identify educational topics needed in the future.

15. Studied the incidence of Very Low Birth Weight births in community hospital settings vs tertiary care centers.

• Identified over 26 % of VLBW infants are born in non tertiary settings.
• Identified this as an important study project for 2011-12.

16. Established 2010-11 Policy Initiatives. Met with House and Senate Health Committee Staff to discuss recommendations.

• Will seek legislation during 2011 to expand the Maternal Mortality Review Team to include Infant Mortality Review.

17. Working with HEPC on developing Center for Health Partnerships.

• Met with Vice Chancellor Dr. Bob Walker to discuss housing Perinatal Partnership within HEPC and establishing the Center for Health Partnerships.
• Met with Chancellor Brian Nolan to discuss housing Perinatal Partnership within HEPC, Office of Vice Chancellor for Health Sciences, establishing the Center for Health Partnerships, and submitting a 2009 supplemental budget request for $450,000 for establishing the Center.
• Chancellor Nolan submitted request for funding to the HEPC. Funding not provided by the State.
• Met with Senate and House Health and Education Chairmen to discuss the need and funding during the 2010 legislative session.
• Met with Governor Manchin’s Chief of Staff in July 2010 to present case for Center for Health Partnerships to be in HEPC.
• Wrote and submitted grant to Claude Worthington Benedum Foundation for $250,000 support the Perinatal Partnership and to work on developing the Center for Health Partnerships - July 2010. Funding awarded and HEPC contracted the work out to WV Community Voices, Inc.
• In December of 2010 met with Governor Tomlin’s Assistant Chief of Staff and Budget Policy Analyst to present the case for funding. Working closely with WV LTC Partnership to develop philosophical partnership base for the project. Visited and spoken with WVDHHR Secretary, Public Health, Medicaid, and Maternal Child Health Director to discuss sustainability of WV Perinatal Partnership and Center for Health Partnership. Visited with MCFH newly named Office Director – December 2010.