Increasing Prenatal Referrals for Home Care Maternal and Child Health Nursing Services in Sullivan County


Impact Statement: 
It has been shown that home visiting and other supportive services provided during pregnancy improve perinatal outcomes. Sullivan County Public Health Services used QI to improve its internal processes for reaching women with high-risk pregnancies, so more mothers and babies can have healthy outcomes.

Over the past few years, as prenatal health care providers have shifted from private practices to large corporations, Sullivan County Public Health Services’ (SCPHS’s) prenatal referrals have dwindled almost to nothing. Empirical data show that home visiting, especially when done by nurses, improves perinatal outcomes, and that high-risk pregnancies are best treated by a range of collaborative services. SCPHS has historically been the sole provider of home-based maternal and child health (MCH) nursing services in the county. This quality improvement (QI) initiative’s purpose was to focus on the problem of increasing collaboration between prenatal providers and SCPHS to improve perinatal outcomes. The QI team was formed from MCH home care nurses, a supervisor from the Healthy Families of Sullivan program, a supervising public health nurse (SPHN), and the assistant director of the Perinatal Network.

Aim statement: Between December 1, 2012 and July 31, 2013, SCPHS will increase the number of referrals received from prenatal health care providers for nursing home care from 1 to at least 50. The committee engaged in three Plan-Do-Study-Act (PDSA) cycles, first using QI tools such as process mapping and a fishbone diagram to study the problem and to identify root causes. The strategies used for improvement were reaching out to providers, developing and distributing service brochures, and performing phone outreach to Women, Infants, and Children Program (WIC) referrals. The team obtained 24 nursing referrals from the phone outreach and 2 referrals from obstetricians/gynecologists (OB/GYNs). Members of the team enjoyed learning about the QI process and plan to continue the initiative after the grant period ends.

Organization that conducted the QI initiative: 

Kennedy, L. Public Health Quality Improvement Exchange. Increasing Prenatal Referrals for Home Care Maternal and Child Health Nursing Services in Sullivan County . Wed, 03/08/2017 - 12:47. Available at Accessed July 25, 2024.

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Submitted by brigit on

This was very helpful to review your process. We also provide Nurse home visits during pregnancy. We do have a very good relationship with WIC and get many referrals from them. We have been able to have a nurse home visitor at some of the WIC clinics to provide health information/ referrals and also talk about the home visiting service. We feel that actually talking/ meeting a nurse helps ease the transition and the clients are more willing to accept the nurse. Over the years we have had about half of our referrals end up refusing or unable to locate. We do try to use motivation when talking to women about nurse home visiting. " Mothers and baby's do better with a Nurse home visitor" One challenge we have is that there are mulptile home visit programs and we try to corrdinate which program is the best fit and not duplicate services. We are independent agencies so that can be a challenge. Thanks

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Grace Gorenflo's picture
Submitted by Grace Gorenflo on

Thanks for sharing your very rich experience! I especially appreciated reading about the outreach to the Orthodox and Hasidic Jew communities. Something I always appreciate about undertaking a PDSA process is all of the learning and ideas that are generated as a result, and your "great ideas" listed under "Other Information" are a perfect example of that. Do you have specific plans to implement any of these, and/or have you already? And now, several months later, have you had an opportunity to continue to track the number of referrals and if so, what have you seen? Thanks!

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Submitted by mschigoda on

Great project - thanks for sharing! I'd be interested to hear an update on your progress as well.

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Melissa Schigoda, MS
Public Health Improvement Program Coordinator
National Network of Public Health Institutes (NNPHI)

Submitted by rpope on

I really appreciate you sharing your experience on this project as my LHD is working on this very issue right now. The fact that your LHD is very similar to ours (rural, high poverty, etc.) also provides us with a lot of useful issues to consider. One of the reasons for enrollment decline in our service district is due to misinformation or lack of awareness on our service availability all together. Most potential clients currently perceive us as an extension of child protective services, which to say the least does not help enrollment into the program. Thanks again for sharing!

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Submitted by Anne M. Waite on

This article has been very helpful. Our local health dept. has been experiencing many of the same challenges. We have few staff available and a very limited budget, but the community needs the services. We are very rural and have a large geographic area to cover. Hooking up with WIC and some of the other services that consumers already access might be a big step in the right direction. Nice to hear the details of the QI process in action! Thanks for sharing!

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