Utilizing Quality Improvement Methods to Address Low Birth Weight Births in Pierce County


Impact Statement: 
This local health department addressed an unacceptable rate of low birth weight births by standardizing their referral process and timeframes; successfully making pre-natal care referrals earlier in the gestation period to ultimately improve the health of newborns in their county.

The Pierce County low birth weight (LBW) rate for singletons was worse than the Washington State rate. We elected to work on improving our internal process for providing Maternity Support Services (MSS) to Medicaid eligible women in our county. MSS includes public health nursing home visits for prenatal/postpartum education and referrals. Our theory for improvement was: If we engage MSS-eligible women early (first trimester) in pregnancy for health promotion education and referral for behaviors and conditions associated with LBW, such as smoking, drug-use, poor nutrition, and lack of medical and dental care, then we can impact positive birth outcomes. Our aim for this project was to increase by 20% the number of referrals who received a Public Health Nurse (PHN) office or home visit within 20 working days from referral (baseline 60%).

Quality improvement (QI) tools utilized for this project included root-cause analysis (fishbone diagram) and also line and Pareto charts. We developed a standardized referral process, a nursing practice standard that all referred clients would be contacted within 10 working days of referral, and created new data collection fields in our existing database to better track trends in contact, referrals, and care. Review of the data became part of weekly staff meetings. Targets were established, and at the sixth and final quarterly review for this project, we exceeded both targets for contact within 10 days and home visit within 20 days of referral. Mean gestation at time of first home visit went from 23.2 weeks to 21.6 weeks, failing to reach the target of 13 weeks. Toward the end of the project period, there were changes in the MSS program, and the project team (Black Infant Health; BIH) refocused to a targeted population. The aim for this project was to increase African American (AA) enrollment in MSS by 10%.

Organization that conducted the QI initiative: 
Tacoma-Pierce County Health Department

Pfeifer, S. Public Health Quality Improvement Exchange. Utilizing Quality Improvement Methods to Address Low Birth Weight Births in Pierce County. Mon, 12/11/2017 - 14:06. Available at https://www.phqix.org/content/utilizing-quality-improvement-methods-address-low-birth-weight-births-pierce-county. Accessed November 29, 2023.

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