Process of Community Review of Assessment Services Teams 1 2

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She also provides significant breast feeding promotion.Availability healthy food or vending at the Piccard site. A vendor could be available at peak

    Maternity Partnership Program Community Review

The Community Review of the Maternity Partnership Program was conducted December 13, 14

    and 17, 2001. The review panel included Dr. Mona Ellis, Dr. T. Earl Flanagan and Dr. Donald


This report is divided into the following four parts:

1. Program Description

2. Process for the Review

3. Summary of Findings, which summarizes the reviewers’ findings about the program’s

    performance in each reviewed area. This part also includes recommendations and

    suggestions for improvements.

4. Review Scale with Results and Comments that includes a description of the areas reviewed

    and the review scale, and the review areas with the panel’s results, comments and scoring.

Program Description

The Maternity Partnership Program is a contractual partnership between the Department of

    Health and Human Services (DHHS) and Holy Cross Hospital to deliver prenatal care to

    uninsured, low-income mothers as a way to improve pregnancy outcomes. This partnership has

    been in place since the fall of 1999. The intention of this partnership is to provide high-quality,

    comprehensive, obstetrical clinical services for DHHS’ grey-zone maternity clients. After a

    client becomes eligible for the program through one of the Service Eligibility Units (SEUs), they

    are assigned a community health nurse case manager, who follows each clients’ pregnancy and

    coordinates care, including home visits. Additionally, each maternity client meets with a

    Community Service Aide (CSA III) at the Piccard Health Center or a staff person at Holy Cross

    who assists clients with Emergency Medical Assistance applications and provides support

    services such as translation assistance/referrals and referrals for clothing. They also help clients

    with enrollment for the Project Access Program and of the baby into the HealthChoice Program.

    All maternity clients are offered dental services up to six months after delivery through the

    Department’s Dental Program.

Services to the maternity clients are offered at Holy Cross Hospital’s Outpatient OB/GYN clinic

    and at a satellite clinic operation at the Piccard Drive Regional Health Center. Holy Cross

    Hospital operates out of the Piccard site two days a week, on Tuesdays and Thursdays, for mid-

    and upcounty clients. All clients are linked to obstetrical care services with 24-hour access.

    Under the County’s Project Deliver Program, the OB/GYN private physicians deliver for these

    clients at Holy Cross Hospital. Clients are linked in reproductive health care/GYN services at

    the conclusion of the postpartum period.

Additional Services the program offers to clients include:

    ? Clients identified as needing perinatal, high-risk consultation are triaged into Holy Cross’

    High Risk OB Program for ongoing management;

    ? Taxi cab vouchers are provided to mid and upcounty clients, as needed, to ensure

    provision of transportation for Labor & Delivery Services;

    ? Crittenton Services provides “in-clinic” prenatal classes in both English and Spanish at

    both Holy Cross and the Piccard satellite site;

    ? Nutrition consultation services are available at the Piccard site by the Vegetarian Institute

    of Nutrition and Culinary Arts (VINCA);

    ? Clients pay a reduced fee for sonogram and genetics consultation services.


Review Process

    Prior to the review, the reviewers met initially with the Program Director of Women’s Health, who monitors the Maternity Partnership Program contract, to obtain an overview of the program.

    They also met with two Accountability and Customer Services staff members to discuss the

    program’s outcome measures. During the review, the panel members spoke with the Public

    Health Senior Administrator for Quality Assurance and Business Relations and the Program

    Director of Women’s Health to better understand the program’s history, the contract and a

    medical audit recently done for the program. The SEU Program Manager discussed how clients

    access the Maternity Program and become eligible for the program.

The panel met with Holy Cross’ Director of Perinatal Services, who oversees both maternity

    clinics. She further discussed the partnership and described how clients are seen at Holy Cross

    and the clinics’ scheduling process. She also talked about high-risk maternity clients. The CSA

    III assigned to the Piccard site explained her work with clients and gave the panel a tour of the

    clinic. The Nurse Administrator at the Piccard Site, who supervises the CSA III, explained the

    use of the Piccard site’s clinic space and literature available for clients. Two Dental Program

    staff members described dental services offered to maternity clients and children. The panel met

    with a nutrition consultant from VINCA to learn about nutrition counseling offered to clients.

    Additionally, one reviewer observed a prenatal class by Crittenton Services at Holy Cross.

To assist the reviewers with their findings the following documents were reviewed:

    ? Program Self-Assessment

    ? Family of Measure Display

    ? Contract with Holy Cross Hospital

    ? Sample of a client record

    ? Dental Records

    ? Information on Oral Health Services for Maternity Clients

    ? Post Assessment Report for Montgomery County DHHS/Holy Cross Hospital Maternity


    ? Information on Maternity Partnership services to clients

    ? Maternity Program’s goals

    ? Program’s Clinical Pathways/Guidelines

    ? Pregnancy Pathway-Patient Teaching Tool ndrd? Unit based Performance Report for Holy Cross clinic, 2 and 3 quarter 2001

    ? Information about VINCA services

    ? Nutrition Information

    ? Information about the FIMR Board






Aspects of the Program that are Highly Commendable

The program demonstrates highly commendable work in the following areas:

? High quality care to a large, diverse and indigent population.

? Excellent service integration with other available programs.

? Impressive coordination of patient care by the Community Service Aide at the Piccard site.

? Impressive health education to clients.

? Dental services for all maternity clients are a valiant effort to treat pre-existing conditions

    that might affect pregnancy outcome.

? Articulated plans for clinical outcome-based research with non-County funding.

? The nutrition consultant gives a much-needed service for free to all Piccard clients. She

    offers additional counseling for appropriate problems e.g., anemia, underweight. She also

    provides significant breast feeding promotion.

Ways in Which the Program is Meeting Expectations

? The program sees all clients who are eligible per SEU assessment.

Aspects of the Program that Need To Be Developed Further

? Outcome measures insufficiently cover goals as stated (see Program Self-Assessment page 1,

    items #1 and #2). Consider including:

    A. Linking of morbidity/mortality outcome with trimester clinic enrollment.

    B. Client satisfaction surveys.

    C. Number or percent of women who access well women/GYN services.

    D. More formal chart reviews regarding adherence to clinical pathways, not just

    documentation issues.

? Implement data gathering and analysis. Re-evaluate strategies periodically to assure

    satisfactory progress toward goal attainment.

? Document unmet needs better to move toward goals (e.g., apparent high incidence of clinical

    depression in clients seen at Piccard).


? The program ideally attempts to provide dental screenings to all clients in the first trimester.

    However, the program should ensure that all clients are referred to dental services for

    evaluation and treatment even if they are late entrants to prenatal care.

Additional Comments and Recommendations

    ? The program’s client charts are not specifically identified, leading to a compromise at times

    of appropriate post-partum referrals to County and non-County services, as well as referrals

    to community health nurses prenatally.

? Consider enlisting private sector group to produce (gratis) a film to be played in waiting

    room. Speakers on the film could detail County and other benefits available (Crisis Center,

    teen support group, counseling for depression, breastfeeding information, etc.). These videos

    ideally should be in Spanish with English subtitles for clients. The program could enlist the

    American Film Institute, media programs at local high schools/colleges/universities. This

    would serve an educational purpose during clients’ lengthy stays in the waiting room.




Aspects of the Program that are Highly Commendable

    ? The CSA III at Piccard has a high level of enthusiasm, dedication and professionalism with

    an impressive depth and breadth of knowledge of both health and social service issues such

    as referrals to County and non-County programs. She displays exceptional interpersonal

    skills and works well with clients.

    ? The Crittenton health educator is an excellent resource and a dynamic speaker who uses great

    techniques during her presentations such as providing healthy snacks and bilingual handouts.

    She is also a strong breast-feeding proponent.

? Program has excellent written and verbal Spanish services.

    ? Individual attention is given to clients from the intake process and throughout their care.

    Service to the client is done with privacy and dignity.

    ? Both Holy Cross Hospital and the Piccard Health Center are accessible by public

    transportation and parking is available.

? A play area for children is located at the Piccard Health Center.

Ways in which the Program is Meeting Expectations

? Piccard clinic facility meets ADA requirements.

? The clinic is a clean, attractive setting.

? Clients can have blood drawn at the Piccard site.

Aspects of the Program that Need To Be Developed Further

    ? Documentation and analysis of customer satisfaction should be developed, especially at the

    Piccard site.

? Recognition of non-English, non-Spanish customer needs.

    ? Availability healthy food or vending at the Piccard site. A vendor could be available

    at peak times (e.g., 10am-12pm) with ready-made sandwiches, yogurt, fruit, juice and

    water to sell in the lobby while patients are waiting. As a suggestion for a food

    vendor, the clinic could use the contracted restaurant vendor located at 1301 Piccard

    (see business card attached to the end of this report).


Suggestions for Improvement

? Repair the TTY machine at the Piccard site.

Additional Comments and Recommendations

? Increase breastfeeding information throughout care (not just at final prenatal session)

    via one-on-one discussions, posters and brochures.

    ? The program should re-evaluate the block scheduling process for client appointments.




Aspects of the Program that are Highly Commendable

? Teams of caregiving staff that work well together both at Holy Cross and the Piccard Health


? Holy Cross employees have extensive training and continuing medical education including

    cultural training and an annual competency fair. They have performance evaluations done on

    a regular basis.

Ways in which the Program Is Meeting Expectations

? In spite of budgetary constraints and heavily burden professional staff, clients are seen and

    receive high quality prenatal care.

Aspects of the Program that Need to Be Developed Further

? More providers are needed at the Piccard site.

? Holy Cross is limited by the number of exam rooms available and when OB/GYN residents

    are called away by other duties.

? Intake process between the community health nurses and the Holy Cross program is

    redundant at times and is not well integrated.

Suggestions for Improvement

? Use non-County resources to augment current financial resources e.g., VINCA, Crittenton

    and other private foundations.

Additional Comments and Recommendations

The budget is strained to serve current client base and census numbers project large increase. A

    definitive plan is needed to handle difference e.g., co-pays or additional funding sources.




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