Improving Access to Prenatal Care in the First Trimester
Access to prenatal care contributes to successful birth outcomes. A Kansas health department found that patients had challenges completing the application process for the Medicaid Children’s Health Insurance Program. By conducting patient education and assistance with the application, the health department increased the percentage of women accessing prenatal care in the first trimester.
The Lower 8 of Southeast Kansas collaborated to address barriers to early prenatal care after identifying that many women did not receive care during the first trimester of their pregnancy. Information uncovered in the Kansas Information for Communities (KIC) identified that the 15- to 24-year-old age group was more likely to receive inadequate prenatal care. In the years 2003–2007, a total of 35% of women in this age group did not receive prenatal care in the first trimester. There were 77 births with no prenatal care received. Data were reviewed, and anecdotal information was collected, revealing that a lack of insurance was a major contributing factor for receiving prenatal care. The Medicaid/Children’s Health Insurance Program (CHIP) application process appeared to be a bottleneck. A goal was set to increase by 2% the number of eligible women in Medicaid/CHIP enrolled by the first trimester. Each public health region represented practiced the same approach with these women while educating them and providing assistance in completion of the application form. Tools for collecting the information were simplified and included a checklist to verify completion of pertinent steps to perform at each visit. All staff were trained on the form and reviewed the Medicaid/CHIP application form and process.
Organization that conducted the QI initiative:
Lower 8 of Southeast Kansas Regional Preparedness Group
Baugher, D. Public Health Quality Improvement Exchange. Improving Access to Prenatal Care in the First Trimester. Fri, 11/16/2018 - 11:21. Available at https://www.phqix.org/content/improving-access-prenatal-care-first-trimester. Accessed May 31, 2023.
Background and Aim
By December 31, 2009, we will promote an increase of 2% in the enrollment of eligible pregnant women in the Medicaid/CHIP program during the first trimester of pregnancy over the previous quarter’s WIC data. Assistance in completing the application and faxing the application to the Kansas Health Policy Authority will be offered to all eligible women.
Need For The QI Initiative:
The Lower 8 of Southeast Kansas collaborated to address barriers to early prenatal care. We had noticed that young women were not receiving prenatal care during the first trimester of their pregnancy. After reviewing data and collecting anecdotal information, it was decided that a lack of insurance was the most likely contributing factor. The application process for Medicaid/CHIP seemed to be the bottleneck.
Area for Improvement:
The 15- to 24-year-old age group was more likely to receive inadequate prenatal care. Between 2003 to 2007, a total of 35% of women in this age group did not receive prenatal care in the first trimester. There were 77 births that received no prenatal care.
● Lack of a uniform approach within a public health region. ● Need for educational information. ● Need for comprehensive Maternal and Child Health (MCH) services. ● Need for Medicaid/CHIP application assistance.
Planning and Execution Details
● Develop a pregnancy testing checklist. ● Standardize pregnancy/history form. ● Make a sample Medicaid/CHIP application. ● Provide training to all staff for the application process.
2/1/09 to 12/1/09
Between 6-12 months
Methods of evaluation:
The region: ● Reviewed best practices and recommendations for increasing the timeliness of prenatal care. ● Collected Women, Infants and Children Program (WIC) data for March to May 2009 for a measurement baseline. ● There were 69.2% of Medicaid/CHIP women who received first trimester care in this time period. ● Combined the questionnaire and checklist into a one-page document. ● Standardized existing pregnancy/history form. ● Made a sample of the Medicaid/CHIP application. ● Developed a checklist for the health departments’ staff to use. ● Provided training to all staff regarding the utilization of forms and the application process. ● Tested the standardized questionnaire/checklist in the Lower 8 health departments beginning July 1, 2009.
Measurable QI Outcomes:
Evaluation of implemented intervention took place in October through November 2009 by the following means: ● Review the survey information collected from WIC clinics of newly pregnant enrollees for the months of July to September. There were 76% of Medicaid/CHIP women who received first trimester care in this time period, an increase of 7.4%. ● Conduct staff meeting to get feedback from all eight health departments on the new process. ● Share feedback with Lower 8 Multi-State Learning Collaborative-3 (MLC-3) team members.
Lessons Learned, Observations and Insights:
Insightful information learned through the process was that prenatal care was not provided for multiple reasons. Education related to the importance of prenatal care needed to be provided for many young mothers who did not understand or know the facts of pregnancy. Physicians in the county who would provide care “before” the state insurance card was issued needed to be provided to the women. Many women needed assistance to complete the application form and needed to be instructed on what forms to submit with the application so it would not be denied. Also state workers supplied information about marking the outside of the application form, which expedited the process at the state office.
● Continue use of the questionnaire/checklist to assist in uniformity and continuity. ● Continue to provide assistance with the Medicaid/CHIP application process. ● Continue to gather WIC data on a semiannual basis. ● Analyze data to determine if the theory continues to achieve the desired outcome.
Training and Preparation
QI Related Training Received:
The eight local health department (LHD) administrators participated in the training. The project was offered through KHI and lasted for 1 year.
Information about the Community
The area served is made up of the eight counties in the lower Southeast corner of the State of Kansas: Chautauqua, Cherokee, Crawford, Elk, Labette, Montgomery, Neosho, and Wilson. The population of the counties ranges from frontier to semi-urban. The area is populated with a large number of needy citizens who are financially and physically depressed with limited resources available. There are high rates of unemployment, teen pregnancies, recreational drug use, and high school dropouts. Available medical care is limited, and there are high numbers with chronic health issues such as obesity, diabetes, heart and stroke, and cancer. There are high numbers of people dependent on State Health Insurance or with no health insurance coverage.
Information about the Health Department
PHAB Accreditation Status:
Planning to submit application for accreditation in the next 3 years
Annual QI Initiative Frequency:
QI activity level:
Other Organization Type:
QI Staff Information
Total number of Staff on QI Team:
QI team members:
Role in the Initiative:
Lead, Project Manager
Role in Organization:
Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community›Standard 1.4 Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions
Domain 3: Inform and educate about public health issues and functions›Standard 3.1 Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness
Partner Organization Types:
Contact Information of the Submitter
Lower 8 of Southeast Kansas Regional Preparedness Group