Early Access Prenatal Project: Eliminating Barriers by Improving Processes


Impact Statement: 
A systematic 9- step approach to manage access to prenatal care was the key to improving access to medical exams within the first 2 weeks of a positive pregnancy test. This systematic approach removed previous barriers that caused a delay in the process from pregnancy testing to initial medical visit.

Prenatal population-based health status indicators for Osceola County, Florida are worse than state and national benchmark comparisons. Outcomes such as low rate of first trimester prenatal care and high rates of low birth weight, prematurity, and infant mortality were particularly evident in our majority population groups (46% Hispanic and 11% black) that have a tendency to suffer greater health disparities.

Osceola County Health Department’s (OCHD's) quality improvement (QI) project goal was to improve access to prenatal care by eliminating barriers that cause a delay in the process from pregnancy testing to initial medical visit. The aim statement was to improve access to prenatal care, by November 2012, by increasing the percentage of pregnant women receiving their initial prenatal medical exam within 2 weeks of a positive pregnancy test, from a baseline of 4% to 75%. This baseline would be our in-process/leading indicator that could ultimately improve the lagging/outcome indicator of first trimester prenatal care. A total of 615 prenatal patients went through the process at OCHD during the QI initiative from March through November 2012.

The QI team used a 9-Step Process Management Model with Plan-Do-Check-Act (PDCA) as a systematic approach to manage its prenatal access process. Monthly in-process data showed an improvement from the baseline of 4% in December 2011 to 39% in November 2012. There were monthly fluctuations in the data that responded to the improvement interventions the team put into place. Although the team did not reach its aim statement goal of 75%, it made an overall improvement of 35% over the project period. Sustainability of momentum will be achieved through linkage to OCHD’s strategic plan and inclusion in our Scorecard of Clinical Performance Indicators that are measured quarterly and reported to senior management.

This QI project is related to Public Health Accreditation Board (PHAB) standards Domain 7, to promote strategies to improve access to health care services, and Domain 9, to evaluate and continuously improve processes, programs, and interventions.

Organization that conducted the QI initiative: 
Osceola County Health Department

Crawford, S. Public Health Quality Improvement Exchange. Early Access Prenatal Project: Eliminating Barriers by Improving Processes. Mon, 02/27/2017 - 12:06. Available at https://www.phqix.org/content/early-access-prenatal-project-eliminating-barriers-improving-processes. Accessed July 25, 2024.

Submission Status: 
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Submitted by lkent on

Good job, everyone. I'm very interested to see how much more improvement you've been able to make since you hired on the additional person. It would be interesting to follow your team's efforts with this through submitting ongoing updates on the improvements you continue to make, and to see if you unearth other issues as you work to improve access to prenatal care and ultimately health outcomes. Keep up the great work!

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