MATERNAL CARE COORDINATION AND PROGRAM TRIAGE
BACKGROUND: Kalamazoo County is rich with community resources, particularly those surrounding maternal and infant care. Unfortunately, these resources are not being utilized by those with the highest risk of poor birth outcomes (defined as birthweight less than 2500g, gestation less than 37 weeks, or an infant death). The primary risk factors associated with these outcomes are poverty, non-white race, and having experienced a prior poor birth outcome.
In 2016, as part of a community wide collaboration, the Cradle Care Coordination Registry was initiated in partnership with seven maternal care programs and WMed, to coordinate available resources. In addition, a hotline (888-KIDS) was implemented at the local 2-1-1 call center to connect women directly to maternal home visiting services. The goal of the registry is to coordinate incoming referrals to eliminate duplication of efforts and better distribute resources.
METHODS: Using the identified risk factors and the individual eligibility of each partnering program, a triage algorithm was developed and administered via Research Electronic Data Capture (REDCap) forms. Upon receiving a call to 888-KIDS, a trained Family Support Specialist uses these forms, containing a series of questions, to walk the caller through the triage algorithm with the goal of determining eligibility for services. In the event that a caller has no program preference but would still like to receive services, REDCap’s randomization function is used to ensure fair distribution of referrals across programs.
Weekly, the seven maternal care programs share their prenatal referral data with the registry via REDCap Send-It or by submitting a spreadsheet to their designated OneDrive folder. To accurately integrate the data, individual data mapping was developed. These weekly data contributions are combined with 888-KIDS hotline data using SQL Server Integration Services. Referral duplication, within and between programs, is identified through the use of fuzzy logic, accounting for misspelled names, incomplete dates of birth, and other variations that could prevent an exact match between records. Final data is then stored in a SQL Server database known as the Care Coordination Registry. Registry data is distributed weekly as Program Lists, containing referral and enrollment information for all the maternal clients seen or referred. Additionally, if any woman has been seen or referred by another program, the information from that program is also included.
RESULTS: A total of 174 program data submissions have been received for registry integration between March 2017 and February 2018. More than 170 Program Lists have been distributed, identifying 379 clients that were referred to multiple programs. When asked, program partners saw several benefits from the registry, including the availability of additional contact information, breakdown of data silos, reduced competition between programs, and increased referral rates.
CONCLUSIONS: Integration of maternal home visiting referrals allows the higher level services to be coordinated and allocated to the highest risk clients. Moving forward, Cradle Kalamazoo aims to expand upon this registry to include postpartum and pediatric (ages 0-1) care, so appropriate services may be coordinated from conception to the first birthday.