Reference Catalog

A Pilot Intervention to Strengthen Coordination Between Primary Care and Prenatal and Early Childhood Home Visiting for Vulnerable Families in Baltimore

Beth Barnet, Margo DeVoe, and Elena Klyushnenkova

Prenatal/early childhood home visiting (HV) targets disadvantaged pregnant women/families. Coordination with primary care (PC) might improve effectiveness, but proven strategies are lacking. Objectives: Pilot a strategy to improve coordination between PC-HV aimed at improving/creating: 1) mutual awareness; 2) relationships/trust; 3) mutually agreed content; 4)  workflows/electronic communications through dedicated staff. Design: Mixed-methods. Qualitative data used to design intervention. Piloted over 12 months, evaluated with pre/post surveys, focus groups. Setting: Baltimore family practice (UFP) and 2 HV programs in community with high rates of low bwt, infant mortality, substance abuse, developmental delay. Participants: UFP-PCPs, HV staff (from 2 sites), patients from UFP receiving services at involved HV sites. Intervention: PCP training (about HV, Pregnancy Risk Assessment (PRA) completion, workflows, new role of UFP-Care Coordinator (CC). HV staff training (discuss abnormal screenings, care plans/concerns with CC). Measures: Number, types, content of communications and who initiated. PRA data from Electronic Health Record. Pre-post PCP/HV staff surveys measured knowledge, attitudes, experiences of coordination. FU focus groups with UFP-HV pts. Results: Between 8/2017-4/2018, 18 patients enrolled, followed through 9/2018 (mean 7.2 mos). UFP PRA completion increased (pre-54.5%, post-75.4%, p<.05). Content: housing, transportation, safety, clarifying health advice, health concerns (depression, appointments, referrals). Most (79%) contacts initiated by UFP-CC trying to reach HV staff, required multiple attempts over days/weeks. At baseline, HV staff expressed low satisfaction with ease of coordinating (9% satisfied); non-significant improvement post-intervention (31% satisfied). HV staff perceived pre/post improvement in effectiveness (27% to 57%, p=.02) but reported worsening electronic access to information over time (29% to 17%). In follow up, UFP-HV pts reported coordination helped with: 1) access to primary care (e.g. help with appts), 2) help navigating referrals, 3)understanding /aligning messages from PCP/HV, 4) enhanced sense of stability/caring from UFP-CC-HV staff. Conclusions: Training PCPs/HV staff can increase mutual awareness and dedicated staff can facilitate coordination. Neither is sufficient without trusting relationships and infrastructure to support connecting in real-time. Shared access to the electronic record or secure messaging might be considered. (author abstract)

Finished

• Collaboration and Coordination