Catholic Health East : Best Practices
Catholic Health East
Best Practice Narrative

RHC: Our Lady of Lourdes Medical Center

 Category:
Developing Healthier Communities

Contact: Marge Cofsky
Telephone: (609)757-3675
Description of the Best Practice: OB INCENTIVE PROGRAM
The Osborn Family Health Center sees over 900 pregnant women yearly. Despite the availability of comprehensive prenatal care services on a sliding fee basis, in 1989, 71 women who delivered at Our Lady of Lourdes Medical Center had no prenatal care. Twenty (20%) percent of those receiving no prenatal care delivered babies who required care in our Intensive Care Nursery as compared to 4% of those receiving prenatal care. The relationship between positive prenatal outcomes and adequate prenatal care has been demonstrated repeatedly in the literature. Preterm delivery is the leading cause of neonatal morbidity and mortality.

The staff surveyed all patients who delivered without the benefit of prenatal care for a six-month period in 1990 in an effort to identify causes and establish workable remediation plans. The survey found four main areas of concern: lack of priority placed on prenatal care by the mother, substance abuse, transportation and inadequate child care. We aggressively addressed all the issues. A full time substance abuse counselor was hired; patients were assisted with transportation concerns, children were welcomed to accompany mothers on their visits. The most challenging was the lack of priority the patient placed on prenatal care. Many of our patients were struggling with everyday survival issues and placed prenatal care as a distant third priority. After many discussions with patients, the OB INCENTIVE PROGRAM was developed.

Implementation
The emphasis of the OB Incentive Program was based on the concept of rewarding positive behavior on a regular basis and de-emphasizing negative behavior. The patient was not penalized for noncompliance with any of the components of the program. A select group of patients were offered the program. Completion of each prenatal visit resulted in a $10.00 Food Coupon redeemable at the local supermarket. Coordination with the Healthy Mothers/Healthy Babies Coalition was essential. The outreach workers referred into the program and followed any of the patients who missed appointments.

Time Frame
The program began in 1991. In the past seven years there were 418 patients delivering in the program.

Financial Profile
The cost of the program is approximately $150.00 per pregnant women. Every prenatal visit plus compliance with lab work etc. results in a $10.00 food coupon.

Outcome
Results of the 418 patients are extremely positive. We were able to compare patients who delivered their last baby with us to this delivery:

Prior Pregnancy Current Pregnancy
Preterm 14.4% 9.7%
LBW 10.90% 9.7%
VLBW 2.7% 1.6%
T-LBW 14.0% 11.3%

Best Practice Narrative is limited to a one page summary.
Supporting data is limited to one page.