Risk Screening
Comprehensive
risk assessment enables the prenatal care provider to determine whether the
woman or the fetus is at increased risk and provides the basis
for further assessment and intervention. Risk factors are characteristics
that indicate a higher probability of adverse outcome and help guide the
action by the woman, social supports, and the medical provider.
One of the recommendations arising out of the Blueprint to Improve West Virginia Perinatal Health in 2006 was to identify a maternal risk scoring instrument to be used universally by all obstetrical medical providers and all payers. A fuller description of the challenge and recommendations for meeting it are contained in the Reports on the Blueprint to Improve Perinatal Health in West Virginia (2008). The Partnership is working to achieve those recommendations.
Maternal Risk Screening Act Becomes Law
Senate Bill 307, “Uniform Maternal Screening Act”, was signed into law on May 28, 2009 by former West Virginia Governor Joe Manchin III. The bill required the Bureau for Public Health, Office of Maternal, Child and Family Health (OMCFH) to convene a diverse maternal risk advisory council to develop a uniform maternal risk screening tool to help pregnant women for potential at-risk pregnancies and to meet annually to revise the tool as needed. The council and OMCFH are required to develop a statistical matrix to measure incidents of high-risk pregnancies.
Preparations started on selecting, appointing and establishing the Maternal Risk Screening Advisory Committee in June 2009. As outlined in the legislation, representatives included at least one private maternity service provider; at least one public maternity provider; representation from each of the State’s three medical schools; at least one certified nurse midwife; at least one representative of a tertiary care center; Bureau for Public Health Commissioner (or designee); and OMCFH Office Director (or designee).
By August 2009 selection and appointment of the Committee was complete. Current Committee members include:
- Dr. Luis Bracero - CAMC Women & Children’s Hospital
- Phyllis Bradley, RN - Camden-Clark Memorial Hospital
- Stephen Dexter, CEO - Thomas Memorial Hospital
- Dr. Kimberly Farry - Associates in Women’s Health
- Lyn Haley, CNM - WV Chapter American College of Nurse Midwives
- Dr. Michael Lassere - Summersville Women’s Health
- Dr. Robert Nerhood - Marshall University
- Stephanie Nicodemus, MSN, CNM
- Dr. Victoria Shuman - Family Medicine of Clarksburg
- Dr. Michael Stitely - WVU
- Tina Williams - United Hospital Center
- Chris Curtis, M.P.H – Commissioner Bureau for Public Health
- Anne Williams – Director Office of Maternal, Child & Family Health
- Jeannie Clark - Director Perinatal Programs, OMCFH
- Kathy Cummons – Director Division of Research, Evaluation & Planning, OMCFH
Due to a number of members experiencing scheduling conflicts, the first meeting was scheduled in January 2010. The purpose of this meeting was to lay the foundation for the work to be tackled by the Advisory Committee. Legislation, general rules, expectations of the Committee and other state’s screening instruments were reviewed. The Advisory Committee was briefed on the preliminary work and surveys completed by the Perinatal Partnership Maternal Risk Screening Workgroup leading to advocacy for the Legislation.
The Committee agreed to adapt the OMCFH, Right From The Start Program’s Prenatal Risk Screening Instrument, which had been widely used by numerous OB providers throughout the State for years. Members wanted to keep the form simple, one page, user-friendly and electronically compatible.
After the Committee’s suggestions were incorporated and a consensus was reached, the new universal screening tool was finalized in June 2010, and now identified as the West VirginiaPrenatal Risk Screening Instrument (WV PRSI). The new tool contains the 4P’s, an opt-in/opt-out for client referral services and an alert to the prenatal provider that the client may need referred for a maternal fetal medicine consultation. Instructions for completion of the form are located on the back.
In May 2010, a second meeting was scheduled to discuss data collection/flow process, referral resources reports for clinicians and strategies for implementation of the PRSI form. The Bureau for Public Health’s Privacy Officer and Legal Counsel attended the meeting to discuss concerns regarding HIPAA compliance.
A dedicated fax number has been established for provider submission of the PRSI form. OMCFH is also using RightFax technology for enhanced data security and privacy protection. When information is received, RightFax temporarily stores the form in a secure access data system which is digitalized and password protected. This virtually eliminates concerns with paper forms and breach of Personally Identifiable Information. All information is locked and secured meeting HIPAA compliance. OMCFH Data Entry Unit is responsible for retrieving the faxed/stored information and entering it in the PRSI web-based data system.
Eventually, OMCFH plans to use Teleform technology. The Teleform system scans the data from forms into a file which is then copied to the PRSI web-based data system, minimizing data entry and possibilities for infractions with Personally Identifiable Information. The PRSI form will have to be converted to Teleform format. OMCFH is also pursuing electronic submission procedures for providers with electronic medical records.
Implementation of this new process was effective on January 1, 2011. All West Virginia maternity service providers were mailed an information packet in November 2010 informing them of this implementation date. The PRSI forms are available free of charge upon request by emailing OMCFH Materials Management at tammy.s.vickers@wv.gov or download from the OMCFH website at www.wvdhhr.org/mcfh.
To date, this process is fully operational Statewide; OMCFH receives forms daily from providers. After about 3-6 months of form utilization and submission, OMCFH will develop a statewide statistical report for the Committee to review and discuss. Once general report content and format meet Committee approval, OMCFH will run the report several times in the first year to monitor/evaluate provider use of the tool. In subsequent years, the report will be run at least annually to measure the incidence of high-risk pregnancies.
The next Advisory Committee meeting is scheduled for April 2011 to review implementation progress, data collection procedures, number of providers participating, development of a statistical matrix, monitoring procedures and any clarification that is needed.
The West Virginia Prenatal Risk Screening Instrument (PRSI) is required for all West Virginia women on their initial obstetrical visit regardless of payment source. Providers shall notify the woman of any identified high-risk condition and provide referrals as necessary. All information submitted is confidential and will not be released/disclosed for any reason other than data analysis of at-risk/high-risk pregnancies and planning purposes by public health officials.
As a result of combined efforts of the Perinatal Partnership, Advisory Committee members and OMCFH, West Virginia will have the capacity to quickly and effectively risk screen pregnant women, then have strong data to drive future practice decisions.