1. CPSP Postpartum Care CPSP Annual Meeting November 14, 2013 Mary Wieg, PHN, MBA, Nurse Consultant III Maternal, Child and Adolescent Health Division Center for Family Health California Department of Public Health 1

2. Objectives Participants will be able to: 1)Describe the need to improve postpartum care 2)Describe the requirements for improving CPSP Postpartum Care in the MCAH Scope of Work 3)Access the sample assessments on the CPSP Web site 4)Identify techniques to assist providers in implementing requirements 5)Plan next steps for working with providers to implement improvements. 2

3. Why Improve CPSP Postpartum Care? CPSP women tend to be high risk Many women still will lose coverage after the 60- day postpartum period Many women don’t return for postpartum care. Postpartum is an excellent time to educate women about the importance of interconception health and link them with continuing services. Reduce risks in future pregnancies by addressing risk factors 3

4. Interconception Risks Recurrence risk varies by diagnosis, but is significant: 15 to 30 percent for Preterm Delivery 20 to 60 percent for Pre-Eclampsia 2-12 fold risk for Low Birth Weight infants Closely spaced pregnancies (<18 months) are associated with increased complications: Low Birth weight, Small Size for Gestational Age, Preterm Birth; Rapid Repeat Birth (<6 months between pregnancies) Infant Death. 4

5. Postpartum Risks Perinatal mood and anxiety disorders (PMAD) –15.3 % experience postpartum depressive symptoms (MIHA, 2011) –10% experience more severe PMAD* –Increases to 25% if history of PPD* Breastfeeding difficulties Medical issues 5

6. Postpartum Needs Medical follow up Psychosocial assessment/follow up Breastfeeding support Family planning Infant care instruction—46.8% always or often bedshare, 66% put baby on back to sleep (MIHA 2011) 6

7. Attendance at Postpartum Care In 2011 (HEDIS 2012): 61.7 percent of Medi-Cal Managed Care clients attended a postpartum visit*, Wide variation by county: High is 77.6 percent, low is 43.8% (see handout)* Compared to: 83.6 percent of women with commercial coverage.* Yet, women on Medi-Cal are at higher risk! *DHCS HEDIS performance measure results, 2012 7

8. Review of CPSP Postpartum Assessments Title 22 requires that the postpartum assessment cover the same areas as the initial/trimester assessments. In 2011 review of postpartum assessments, many assessments were missing important items. PHCC concurrently developed interconception guidelines 8

9. Items missing from one or more PP assessments Birth Outcome: gender, birth weight, GA, delivery method, any maternal complications Health Education: Environmental/Occupational exposures Dental (mother and baby) Follow up of medical problems Postpartum discomforts Infant care/safety (SIDS) Family Planning: Plans for future children Assessment for reproductive coercion/ BC sabotage Psychosocial: Follow up of MH issues Coping with demands of baby PMAD screening Relationship health Substance use (AOD, smoking) Nutrition: BMI Support for Breastfeeding Required referrals Family planning, Dental, WIC, genetic screening, CHDP Other referral : perinatal home visiting 9

10. PHCC Interconception Guidelines Improving preconception and interconception health to improve birth outcomes is a strategic priority of MCAH, HRSA, CDC, ACOG and the March of Dimes 2006: formed the Preconception Health Council of California (PHCC) MOD, ACOG District IX and PHCC developed evidence-based guidelines for interconception care. MCAH is promoting these in CPSP 10

11. Interconception Care Project of California (ICPC) Content Areas Alcohol Use* Anemia Domestic Violence* Gestational Diabetes Gonorrhea and Chlamydia Hepatitis HIV Chronic Hypertension Migraine Overweight/Obesity* Postpartum Depression* Preeclampsia Preterm Birth Cesarean Section Seizure Substance Use Syphilis Thrombocytopenia Thyroid Disorder Tobacco Use* Vaccinations 11

12. ICPC prevailing messages Three standard interconception messages that ALL women should receive at the post-partum visit Messages printed on Patient Algorithms and Provider Handouts 12

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15. SOW 2.9 Requirements Work with MCAH and CPSP providers to maximize the quality and utilization of postpartum care –Revise postpartum assessment forms and protocols PHCC Interconception Guidelines –Perinatal depression –Reproductive coercion/birth control sabotage –Improving support for breastfeeding http://www.everywomancalifornia.org/postpartumvi sithttp://www.everywomancalifornia.org/postpartumvi sit Report activities in the Annual Report 15

16. Next Steps Share this information with your providers Encourage them to incorporate the interconception guidelines into their practice Resources provided to facilitate this Report activities and provider response in the Annual Report 16

17. Resources Available on the CPSP Web site Insert “cdph.ca.gov/cpsp” into search engine –PSC Forms for Local Use Two assessment form formats –Integrated assessment and care plan (two-column form) –Separate Assessment and Care Plan forms Handout on missing items can be an aid for modifying assessments and protocols Refer to online provider training for recommendations. 17

18. Discussion 1)What techniques have you found helpful in encouraging providers to incorporate practice improvements? 2)What are some next steps you can take to help providers to implement improvements? 18