UAB Magazine Weekly - Features on Health Care
A Strong Start for At-Risk Moms and Babies
By Christina Crowe and Matt Windsor
Drummonds recently visited UAB to deliver the 2013 Ann Dial McMillan Endowed Lecture in Family and Child Health in the UAB School of Public Health. He shared lessons from his group's successful efforts to improve the health of mothers and infants in central Harlem. (Learn more about the NMPP's success and Drummond's call to action at UAB in this related article.) "Mom's health," Drummonds says, is "always secondary. Part of our job is to make her health, as well as the overall health of the household, primary."
Maternal and child health is a major challenge in Alabama. "High rates of premature birth, obesity, diabetes, hypertension, and substance abuse plague our state," says Joseph Biggio, M.D., professor of medicine and director of the UAB Division of Maternal and Fetal Medicine. But thanks to a major grant from the federal Centers for Medicare and Medicaid Services, UAB can now offer intensive help to mothers and babies with the greatest needs.
The goal of the Strong Start for Mothers and Newborns initiative is to identify the best ways to prevent significant, long-term health problems for high-risk pregnant women and newborns enrolled in Medicaid or the Children's Health Insurance Program. In addition to UAB, 26 organizations across the United States are taking part in the Strong Start initiative.
Alabama's Medicaid Maternity Care Program currently does not provide non-medical social services to promote healthy living and reduce poor pregnancy outcomes. UAB's four-year, $730,000 Strong Start grant will address that gap by enhancing services offered at UAB clinics in and around Jefferson County. It includes enhanced screening for substance abuse, including illicit drugs as well as tobacco; social support for women with domestic issues such as income or domestic violence; screening for depression; and nutrition and dietary counseling.
Successful Maternal-Child Outreach in Harlem Offers Lessons for Alabama
By Christina Crowe
Mario Drummonds entered the world of infant and maternal care as a businessman looking for a career change. He brought nearly 20 years of corporate experience to the nonprofit Northern Manhattan Perinatal Partnership (NMPP) in the early 1990s, answering the group's call for a CEO in a desire to serve a very familiar neighborhood.
School of Public Health. "I was at a career interlude when I submitted my resume to the NMPP and didn't expect them to call me. I was very honest with the board of directors about my lack of knowledge about maternal health. I made the argument that they didn't need another doctor or nurse, but someone to take the agency to the next level of development.""I was born in Harlem in the old Harlem Hospital," says Drummonds, who visited UAB in February to deliver the 2013 Ann Dial McMillan Endowed Lecture in Family and Child Health at the
Since that initial interview nearly 20 years ago, Drummonds has taken the NMPP from an annual $800,000 budget to one 10 times that size, and delivered impressive results. The partnership took a single Zip Code—a four-block area of central Harlem—and coordinated pre- and perinatal services for the women and babies living there. In 1990, central Harlem's infant mortality rate was 27.7 deaths per 1,000 live births. Fifteen years later, that number had plummeted to 7.4 deaths per 1,000 live births.
Organize and Mobilize
The main tactic the NMPP has employed under Drummonds is to organize and mobilize existing services, bringing in outside agencies to fill any gaps, he says. There are multiple state and federal in-home visiting programs, and they "don't communicate with each other on a neighborhood or regional level," Drummonds says. "You have representatives from Healthy Families, Healthy Start, and Head Start, all possibly talking to the same moms. That is a waste of a lot of human capital when you don't coordinate. That would never happen in our four-block zone. We deploy people so there won't be an overlap."
One of NMPP's recent campaigns aims to address the mental health needs of pregnant women and new mothers. The partnership's Harlem Maternal Mental Health Training Institute, funded by a grant from the New York City Department of Health, has trained approximately 500 clinicians, psychologists, psychiatrists, and social workers "to understand the epidemiology behind maternal depression," Drummonds says. "They were used to dealing with regular depression, not perinatal depression."
Specialist clinicians at area medical schools provided the training, teaching "obstetricians, midwives, and pediatricians to ask mothers how they are doing—not just how the baby is doing—after birth," Drummonds says. The institute then hired several of those clinicians to go out to community-based organizations and treat moms before, during, or after birth.
"We're striving to put the 'mother' back in maternal child health," Drummonds explains. "We're asking, 'When are you going back to school? Are you building a meaningful relationship? How can you extend the interpregnancy interval—which should be 18 months or more—and how can we manage hypertension, diabetes, obesity?'"
Room for Improvement
While the lecture was Drummonds's first visit to Alabama, he sees parallels between health care gaps in the state and in the heart of Harlem. Max Michael, M.D., dean of the UAB School of Public Health, agrees—and that's part of the reason he invited Drummonds to present the lecture.
"For a section of Harlem to have a strategy that in 10 to 12 years reduced infant mortality rates below the mortality rates of white infants in Alabama is remarkable," Michael says. "But it's one thing to reduce infant mortality in an urban housing community and another to do something comparable in Alabama. So much of the effort here has been getting people into prenatal visits. What they did in Harlem was way beyond that, starting care in the first trimester, rather than the second or third. It also went beyond the medical aspect—they're doing things like kicking smokers out of the house or kicking out boyfriends who use drugs, for example."
Some help for addressing this issue in Alabama is on the way: In March 2013, the Centers for Medicare and Medicaid Services announced that UAB's Department of Obstetrics and Gynecology, along with 26 other organizations across the country, will begin participating in its Strong Start for Mothers and Newborns initiative. UAB will receive $730,000 over the next four years to find new ways to prevent significant, long-term health problems for high-risk pregnant women and newborns enrolled in Medicaid or the Children's Health Insurance Program. Learn more in this article.
Call to Action
In his McMillan lecture, Drummonds emphasized the need for strong leadership to advocate for women and children. Leaders in the community, academia, and business "need to converge and create a sense of urgency," Drummonds said. "They must create a new mood in town that says, 'This is unacceptable—here are some of the things we're going to do from a policy and program perspective to turn the tide,' and then hold themselves accountable to find results."
After a day of meeting with UAB faculty, clinicians, and others, Drummonds said that attitude seems to be present in Birmingham: "The dial has been turned up around the need to do something different about both disparities and infant mortality in the state of Alabama."
High-Tech Devices Enhance Patient Care
By Tara Hulen
Some of the most important medical treatment advances in recent years have been quiet ones—high-tech devices that transmit crucial information from patient bedsides, recording a wealth of data to improve care. Nurses spend less time entering data and more time with patients. The potential for errors is lower. Care-team members can see new records right away instead of tracking down paper charts. And patients enjoy peace of mind knowing that everyone treating them is on the same page—or accessing the same computer file.
Electronic medical records (EMRs) are becoming commonplace in physicians’ offices and hospitals around the country, in part because new federal rules require their adoption. UAB adopted electronic records technology early, beginning in 2008; since then, the medical center has rolled out sophisticated systems that can quickly enter patients’ vital signs directly into their EMRs, monitor drug delivery, and instantly notify health-care teams of important changes in patients’ conditions, among other tasks.
“The goal is to create a complete and fully integrated EMR with immediate electronic synching of all patient data, available to everyone on the health-care teams at the same time,” says Joan Hicks, UAB Health System chief information officer. The benefits from systems already in place, Hicks says, are a return on investment that is “more than compelling.”
Take a closer look at a few of the new technologies connecting patients, caregivers, and treatments:
By Gail Allyn Short
This year, an estimated 785,000 people will experience their first heart attack, according to the American Heart Association. During that same period, some 470,000 people, who have already had one or more heart attacks, will have another. But an intervention program known as cardiac rehabilitation could help reduce both of those sobering figures.
Health professionals working with cardiac rehabilitation develop individualized plans for cardiology patients that target specific problems such as poor diet, stress, smoking, lack of exercise, and other lifestyle factors that affect heart health.
UAB cardiologist Vera Bittner, M.D., medical director of the Coronary Care Unit and the UAB Cardiac Rehabilitation Program, recently reported that, in an analysis of data taken from the Medicare database, cardiac rehabilitation lowered the death rate among participating patients by as much as 35 percent compared to non-participants with similar heart problems.
Living Longer and Healthier with Cystic Fibrosis
By Gail Short
Cystic fibrosis (CF) was once exclusively a child’s disease. Until the 1960s, most sufferers died before reaching grade school.
A deadly, autosomal, recessive disorder, CF causes thick, sticky mucus to clog the lungs and digestive system. Patients experience shortness of breath, wheezing, and dangerous lung infections, and their bodies have a harder time absorbing nutrients from food. But today they’re living longer, helped by advances including new drugs and nebulizers, high-fat diets, and supplements to replace digestive enzymes.
“Life expectancy has grown exponentially,” says Veena Antony, M.D., a professor in the UAB Division of Pulmonary, Allergy, and Critical Care Medicine. “Today the median is about 38 years. Some of my patients are in their 60s, and one is over 70.” For patients who outgrow pediatric CF services, UAB’s Adult Cystic Fibrosis Program helps them manage their own care.
“Our goal is to help patients lead normal, adult lives,” says Antony, the program’s director. “Most of them do so despite having a disease that has so much disability attached to it.”
Patients in UAB's Adult Cystic Fibrosis Program meet with a physician, respiratory therapist, nurse practitioner, dietician, and social worker on the same day for updates on lung function, body weight, and overall health.
Established in 2000, the program has an 11-member staff that provides comprehensive care to more than 160 patients.
When those patients visit UAB, they meet with a physician, respiratory therapist, nurse practitioner, dietician, and social worker on the same day for updates on lung function, body weight, and overall health. They also receive counseling to help them manage school, work, or major life changes that can impact their health, Antony says.