The OB Challenge Family Centered Care

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The OB ChallengeFamily Centered Care

• LTC E Cameron Ritchie, MD
• Program Director, Mental Health Policy and
  Womens Health Issues
  
• OASD/Health Affairs

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Patient Dissatisfaction with OB Care

• Drawn from Picker Survey, Service surveys, recent
  TMA Survey
  
• Areas of Discontent
• access to gynecological care
• variable continuity of care
• difficulty getting appointments
• no routine 2nd trimester ultrasound
• poor communication
• suboptimal pain management

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Patient Discontent (cont)

• want private rooms post-partum
• lack of parking
• lack of child care
• hotel amenities
• hospital may be relatively far away

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Legislation

• FY 2002 National Defense Authorization Act
  eliminates the requirement for nonavailability
  statements or preauthorizations for TRICARE
  Standard OB patients.
• Effective NLT 28 December 2003
• Patient out-of-pocket expenses will cost 25 to
  go downtown for OB care
  

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Threat Assessment

• Immediate Threat
• Potential loss of 7 of MTF OB workload
• Standard patients who currently deliver in MTF
• Long-Term Threat
• Potential loss of TRICARE Prime enrollees
• Reduced patient volume may affect GME and impact
  readiness
  
• Impact on GME in OB, Family Practice, General
  Surgery, Pediatrics, Transitional Interns
  
• Potential loss of 30 of MTF OB workload
• Prime patients may dis-enroll
• Cost estimates 72-75 million dollars

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Estimated Government Costs
Costs in millions
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TRISERVICE Proposed Solutions Short and
Intermediate Term

• Family-centered care
• Improved access to gynecological care
• Continuity of antepartum care by individual or
  team
  
• Improved pain management
• Improved post-partum continuity of care

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Short and Intermediate Term Solutions (cont)

• Better marketing (locally and globally) of
  quality of care
  
• Improved communication between patient and
  provider
  
• Availability of childcare
• Providing private rooms post-partum

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Proposed Solutions Long term

• Increasing the number of private post-partum
  rooms
  
• Increasing the number of Labor and Delivery Room
  Postpartum (LDRP) rooms
  
• Supporting mid-trimester ultrasound as a routine
  service
  
• Exploration of increasing partnership with
  civilian facilities
  
• Facility-specific decisions will need to be made
  whether to expand, divest, partner, build

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Uniform Product Line

• Family-centered care
• Father, significant other, siblings are invited
  and welcome to participate in prenatal visits and
  birth
  
• State of the Art, quality care
• Follow the guidelines of the American College of
  Obstetrics and Gynecology, American Academy of
  Pediatrics, American Academy of Family
  Physicians, the American College of
  Nurse-Midwives, Association of Womens Health,
  Obstetric and Natal Nurses
• Friendly patient and family centered staff
• Quality communication between patient and
  provider
  
• We will answer your questions and concerns
• Individualized birth plans
• Continuity of prenatal, perinatal and postpartum
  care by individual or team
  
• You will have your own doctor, who is part of a
  team that will know you and your medical needs
  
• Comprehensive personalized pain management to
  meet your needs
  
• Epidurals or other appropriate anesthesia
  available
  
• Post-partum pain management
• Safe, secure facilities
• JCAHO-accredited hospitals

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Uniform Product Line (2)

• Access to gynecological care within established
  standards
  
• Increased ease of getting appointments
• TRICARE on line, appts offered before leaving,
  better telephone access, schedule well-baby
  follow-up before leaving hospital
  
• Individualized prenatal education
• Classes, pamphlets, videos, websites
• Information on nutrition and exercise
• Improved parking
• Reserved or valet parking 3rd trimester
• Stork parking after birth
• Mid-trimester ultrasounds
• Still controversial whether it should be
  routine
  
• Meet babys future provider before baby is born
• Private rooms post-partum
• Lactation support programs
• Admission/discharge paperwork at bedside
• TRICARE and DEERS enrollment of baby prior to
  discharge
  

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Metrics of Improvement

• Three tiered data collection
• Quantitative data (randomized surveys)
• Qualitative data, (eg focus groups)
• Rapid feedback (convenience samples)
• Possible metrics
• Single MHS report card on each facility
• National Perinatal Information Center (NPIC)
  Data
  
• 18 MTFs with the largest number of deliveries
• Prime disenrollment (POC Lead agents)
• Patient satisfaction
• Picker Jan 03 (POC TMA)
• Interactive Customer Evaluation (Navy) (kiosk,
  web-based)
  
• Number of deliveries at MTFs (POC HA)
• Number of deliveries by Standard patients (POC
  Lead agents)
  
• Market share (POC TMA)
• DoD TRICARE Survey
• Customer Service Feedback
• ORYX (clinical outcomes)

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Major Messages

• Childbirth is a major event for a family, and we
  are privileged to provide care for your family
  during this special time. Our primary goal is to
  meet your personal health care needs.
• We understand the unique needs of military
  families. Every year, we help to bring over
  50,000 babies into the world in our hospitals.
  
• We offer state of the art quality care. We are
  experienced in providing the best in maternal and
  neonatal care.
  

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Questions?

• We appreciate your feedbacknow and in the future.