An innovative community program puts the science of evidence-based care behind the art of preventing preterm births among women at risk

Fueled by a decades-long, higher-than-average rate of pre­term birth and infant mortality in this region, Cincin­nati Children’s physicians and researchers have a vested interest in determining why babies are born too early.

Experts here are tackling the problem on multiple fronts, but answers remain elusive. Until we know more, we continue to expand community-based efforts to curb the incidence of prema­ture births among the most vulnerable women.

Innovation Where It Matters

One such effort has brought Cincinnati Children’s, the Univer­sity of Cincinnati (UC) and the Cincinnati Health Department together in a novel approach to reducing the incidence of preterm births. The program targets poor, uninsured minority women, the group most at risk of giving birth to very early, small and fragile babies.

The program grew out of an innovative program started by Elizabeth Kelly, MD, an obstetrician-gynecologist with UC’s De­partment of Obstetrics and Gynecology and Director of the Di­vision of Community Women’s Health. Kelly has worked with disadvantaged women for more than two decades. She is well ac­quainted with the inequities and obstacles they face in receiving prenatal care. Giving birth to the earliest and most frail preterm babies is one of the most devastating results of those inequities.

Kelly knows that a major obstacle facing the women she serves is making and keeping prenatal appointments. Lack of transportation, no child care, job demands, struggles with food and housing all contribute to a perfect storm of reasons why dis­advantaged women do not receive needed prenatal care. So a few years ago, she began offering same-day access to prenatal care at one of the Cincinnati Health Department’s health centers.

Removing Barriers

“A woman could walk into a health center, get a pregnancy test, and we offered her care that day,” Kelly says. The clinic made allowances in staffing and schedules to accommodate the enthusiastic response. It was a positive first step.

Before long, quality improvement (QI) specialists in the Ander­son Center for Health Systems Excellence at Cincinnati Children’s learned about Kelly’s same-day program and asked if they could work with her.

Together, they identified four evidence-based interventions that are crucial to ensuring a healthy pregnancy and reducing infant mor­tality:

  • Providing same-day access to care
  • Addressing “social determinants,” the social and economic issues that affect a woman’s health
  • Help to stop using tobacco and other harmful substances
  • Ensuring a safe sleeping place for newborns

The program now operates in the Cincinnati Health Department’s Elm Street and Price Hill Health Centers and receives strong support from community organizations. Women who receive prenatal care at those centers have access to most of the interventions; the tobacco cessation portion is still in development. The QI specialists ensure that interventions are offered systematically and track outcomes – which they hope will be healthy, full-term babies.

Robert Kahn, MD, MPH, Associate Director of General and Community Pediatrics at Cincinnati Children’s, worked with the QI team and Kelly to put the interventions in place.

“It’s been fantastic to have an obstetrician as a partner because child well-being is so dependent on a healthy pregnancy,” Kahn says. “Dr. Kelly and her team at the Cincinnati Health Department clin­ics are incredibly committed to the women they serve and to achiev­ing improved birth outcomes.”

Paving the Way for a Healthier Pregnancy

Kelly welcomes “putting science behind” what her years of experi­ence have taught to be major obstacles to receiving good prenatal care.

“Until a woman is free of things like being a victim of domes­tic violence, and has heat in her home, and food, and a ride to her appointments, it’s pretty hard for her to adhere to her health care,” she says. “The QI team is providing their expertise in improvement science to implement and measure the impact of removing some of these barriers.”

Although it remains too early to report the program’s impact, Kelly has already seen some positive results.

“Our patients love it,” she says. “They are genuinely concerned about their health and the health of their babies. This program al­lows more of their basic needs to be met so they can focus on staying healthier.”