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Service Delivery Innovation Profile

Bilingual, Culturally Competent Managers Enhance Access to Prenatal Care for Migrant Women, Leading to Potential for Improved Birth Outcomes


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Snapshot

Summary

The Migrant Clinicians Network Prenatal Care Program seeks to ensure continuity of care for expectant mothers who begin prenatal care in one location and move for employment purposes during their pregnancy. Bilingual, culturally competent staff link these migrant patients with prenatal services and manage their medical records throughout the pregnancy. Although the health outcomes of participants have not been formally evaluated, data suggest that the program is enhancing access to prenatal services and continuity of care in a population that has no other means of accessing such services.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation birth outcomes from a small, nonrandom sample of patients and an internal evaluation of staff performance, as well as anecdotal evidence based on feedback from clinicians and program participants.
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Developing Organizations

DeSoto County Health Department; Migrant Clinicians Network
The Migrant Clinicians Network is located in Austin, TX. DeSoto County is in Florida.end do

Date First Implemented

2001
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Patient Population

Vulnerable Populations > Transients/migrantsend pp

Problem Addressed

Patient mobility is a significant barrier to high quality, continuous health care among migrant workers, especially for women. Pregnant migrant women are often unable to access regular prenatal care, thus putting them at higher risk for preterm labor and other complications.
  • Losing track of mobile patients: Most clinics do not have staff dedicated to keeping track of patients who have moved beyond their local catchment area. The usual strategies for tracking down mobile patients include calling the last known telephone number, mailing a certified letter, or sending an outreach worker to find the patient. These strategies are often ineffective if the patient has moved to a new area. In addition, clinics often do not have access to the medical records of migrant workers.
  • Migrant women face multiple barriers to continuous care: Migrant women face multiple barriers to continuous care, including a migratory lifestyle, lack of transportation, insufficient financial resources, lack of insurance, language barriers, and lack of cultural competence among health care workers.1,2
  • Lack of continuous prenatal care leads to more adverse outcomes: Health care providers try to see women at prescribed intervals during pregnancy, administering a variety of examinations, laboratory tests, and educational and support services that are dictated by the progression of the pregnancy. Women who do not receive early and regular prenatal care are less likely to have healthy infants than those who do. Inadequate prenatal care can result in higher rates of preterm births and other adverse outcomes.2,3

What They Did

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Description of the Innovative Activity

The Migrant Clinicians Network Prenatal Care Program maintains continuity of care for expectant mothers who move during their pregnancy through a prenatal care coordination program. Program staff assist expectant mothers and their health care providers throughout the course of their pregnancy, with the goal of bridging gaps in care and improving health outcomes. Key elements of the program include the following:
  • Patient enrollment: Pregnant migrant women receive referrals to the program, typically from outreach workers. A family support worker provides information to each woman on the goals of the program, assists them with the enrollment process, and obtains authorization to release their medical records. Each woman then calls the program's toll-free number to get acquainted with program staff via the telephone; the purpose of this call is to build trust between the client and staff.
  • Periodic calls to coordinate care: Bilingual, culturally competent staff (known as "health network associates") contact patients regularly to check on their status and encourage continuity of care. Staff provide several services during these phone calls, including educational advice and support, updating of contact information, finding needed services (including obstetric clinics and medications) in the local area, and scheduling appointments. In addition to calling patients, staff contact hospitals and assistance agencies on behalf of patients to arrange for services that can help them overcome language, transportation, and other barriers. The program generally provides these periodic care coordination services until the 6-week postpartum visit.
  • Maintenance of patient records: The program maintains a central storehouse of enrollee medical records. A patient's health care provider (regardless of geographic location) can call the program's toll-free line to request an up-to-date copy of the patient's medical record. Program staff can also find health care providers for patients before they move, transferring medical records to them to enhance continuity of care.
  • Health network cards: Enrollees receive wallet-sized health network cards that can easily be carried wherever they go. The toll-free number on the card enables health clinics to call for the patient's medical records if necessary. Mobile patients can also call the program's toll-free line for help locating treatment facilities at their next destination.
  • Ongoing management and quality oversight: The health network manager reviews all patient enrollments, rank ordering them in terms of urgency. The manager also monitors followup lists and reviews procedures for closing out cases after the 6-week postpartum visit.

Context of the Innovation

The Migrant Clinicians Network is a nonprofit organization consisting of clinicians dedicated to improving health care for migrant workers. The organization addresses the unique health care needs and barriers faced by migrant families through leadership, innovation, collaboration, and support to health care providers. The organization founded its Prenatal Care Program in response to clinician-raised concerns about the challenges of keeping track of migrant patients, particularly pregnant women. The organization designed the Prenatal Care Program based on several other medical record assistance programs it had already implemented, including programs focusing on tuberculosis and diabetes.

Did It Work?

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Results

Although the health outcomes of participants have not been formally evaluated, post-implementation data suggests that the program is enhancing access to prenatal services and continuity of care, both of which are important for healthy births, in a population that has no other means of accessing such services. Participants and providers anecdotally report high levels of satisfaction with the program.
  • Enhanced coordination of prenatal care: An internal evaluation of seven charts showed an average score for prenatal staff performance of 98.3 percent (out of 100). The scores are based on several measures of care coordination, such as the collection of demographic information and medical information, documentation of all case management notes, patient contact notes, and enrolling new referrals within 48 hours. This score suggests that the program provides thorough, appropriate followup services that encourage continuity of care.
  • Potential improvements in birth outcomes: During the program's first year (2001 to 2002), five participants successfully delivered healthy babies, while one participant had a miscarriage; three women were lost to followup. During that same year, five of nine participants had their records successfully travel with them during the course of the pregnancy. In the second year, 13 participants received 103 contacts from Health Network associates (suggesting high levels of care coordination). During that year, 9 of 11 participants (two who did not move were excluded) delivered healthy babies, with one delivering prematurely and one being lost during followup. In 2006, the program served 33 women; all 33 pregnancies resulted in healthy, full-term births. Since that time, the program serves approximately 30 women per year.
  • Significant cost savings: When someone does not have documented prenatal care or medical records at the time of delivery, the pregnancy is assumed to be high-risk and emergency preparations must be put in place, including additional staff. These additional costs can be avoided by ensuring that patients have documented care when they present at the hospital. Based on the 2006 results, the potential cost savings is $286,605 (based on the average cost difference between a complicated and uncomplicated birth).
  • Satisfied patients and providers: Consistently positive feedback from program participants and health care providers indicate that the program has improved access to services and the ability of providers to maintain continuous care.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation birth outcomes from a small, nonrandom sample of patients and an internal evaluation of staff performance, as well as anecdotal evidence based on feedback from clinicians and program participants.

How They Did It

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Planning and Development Process

Key steps in the planning and development process include the following:
  • Collaboration with county health department: Utilizing an established relationship, the Migrant Clinicians Network partnered with the DeSoto County Health Department to develop enrollment protocols and materials for the program (e.g., participant cards).
  • Training: Current staff periodically train new health network associates as they join the program; training focuses on how to contact and interact with patients and clinicians.
  • Implementation of pilot project and data collection: The program launched as a pilot program in 2001, enrolling migrant pregnant women who had clear travel plans, as well as those who knew they were moving (but did not know where). The pilot program remained unfunded for the first few years but was converted to a full program in 2006 when outside funding was secured from the Denver Foundation. Data have been collected since the program's inception in 2001.

Resources Used and Skills Needed

  • Staffing: The program employs the health network manager and three full-time health network associates, who split their time between this and other similar Migrant Clinicians Network programs.
  • Costs: Costs are shared across programs, and therefore, difficult to estimate. However, the primary cost is staff time, as the program is very labor intensive. Other ongoing costs include long-distance phone and fax services and maintenance of the database.
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Funding Sources

Health Resources and Services Administration; The Denver Foundation
The Migrant Clinicians Network funded the program for the first few years. The postpilot project received funding from the Denver Foundation in 2006. The Migrant Clinicians Network also received a small amount of additional funding through the Health Resources and Services Administration to provide bridge case management training and technical assistance services to migrant health centers.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Simplify the process for patients and providers: Ensure that the process of accessing care is as user-friendly as possible. Allow patients and clinicians to access medical histories via a toll-free phone number, and supply patients with durable, portable health network cards.
  • Utilize existing technology: Use existing, low-cost technology to maximize the number of health centers involved and to minimize costs.
  • Hire culturally and linguistically appropriate staff: Utilize expert, bilingual, culturally competent staff to answer treatment questions and to offer information about resources and referrals. This will help patients feel safe and comfortable accessing care.
  • Ensure confidentiality: The success of this program depends upon the trust of participants. Ensure that all patient medical information is kept secure and confidential.

Sustaining This Innovation

  • Secure ongoing funding: Continue to identify potential funders and market your program. This is key to sustaining the initiative.
  • Keep administrators engaged: Share the program's progress with administrators on an ongoing basis to ensure organizational support for helping the women to stay in care.

More Information

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Contact the Innovator

Deliana Garcia, MA
Director, International Projects, Research and Development
Migrant Clinicians Network
P.O. Box 164285
Austin, TX 78716
(512) 327-2017, x 4501
E-mail: dgarcia@migrantclinician.org

Innovator Disclosures

Ms. Garcia has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

The Migrant Clinicians Network website is available at http://www.migrantclinician.org/.

Footnotes

1 Arcury TA, Quandt SA. Delivery of health services to migrant and seasonal farmworkers. Annu Rev Public Health. 2007;28:345-63. [PubMed]
2 National Latina Institute for Reproductive Health. The reproductive health of migrant and seasonal farm worker women [Web site]. December 2005. Available at: http://latinainstitute.org/sites/default/files/publications/MgrntFrmwkrs-4.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
3 March of Dimes. Prenatal care [Web site]. May 2008. Available at: http://www.marchofdimes.com/pregnancy/prenatalcare.html
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: April 14, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: December 04, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: April 23, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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