The Fountain Project:

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The Fountain Project Toward an Integrated
Model for Evidenced-Based Preconceptual Care
Betty E. Cook, MA, Kansas City University of
Medicine and Biosciences V. James Guillory,
D.O., M.P.H., Kansas City University of Medicine
and Biosciences Airick Leonard West, Ivanhoe
Neighborhood Council Jinwen Cai, M.D., Gerald L.
Hoff, PhD, Josie Manning, R.N.C., M.S. Kansas
City Health Department Paul C. Dew, M.D.,
M.P.H., Kansas City University of Medicine and
Biosciences
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The Fountain Project

• COORDINATES and INTEGRATES
• The Quantitative Data Analysis of PPOR
• WITH
• The Qualitative Data Analysis of Fetal and Infant
  Mortality Review

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Map Feto-Infant DeathsKansas City, MO Overall,
1998-2002
395 fetal and infant deaths
Maternal Health/ Prematurity 161
Total fetal deaths and live births 36,593
Maternal Care 85
Newborn Care 54
Infant Health 95
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Map Feto-Infant DeathsBlacks, KCMO, 1998-2002
226 fetal and infant deaths
Maternal Health/ Prematurity 99
Total fetal deaths and live births 13,532
Maternal Care 47
Newborn Care 23
Infant Health 57
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Reference KCMO non-Hispanic white women aged
20, with 13 yrs education, 1998-2002
55 fetal and infant deaths
Maternal Health/ Prematurity 1.7
Total live births and fetal deaths 10,610
Maternal Care 1.4
Newborn Care 1.3
Infant Health 0.8
Total feto-infant mortality rate 5.2
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Focus on Overall Feto-Infant MortalityBlacks,
KCMO, 1998-2002
Maternal Health/ Prematurity 7.3
Total feto-infant mortality rate 16.7
(226/13,532)x 1000
Maternal Care 3.5
Newborn Care 1.7
Infant Health 4.2
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Excess Feto-Infant MortalityBlacks, 1998-2002
KCMO Blacks
Reference
Excess
7.3
1.7
5.6
-

3.5
1.7
4.2
1.4
1.3
0.8
2.1
0.4
3.4
-

16.7
5.2
11.5
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Level 3 PPOR Analysis
Infant Causes of Death KCMO 1998-2002
Category VLBW LBW NBW Total
SIDS 2 5 40
47 20.4 Perinatal Conditions 61 10
14 85 37.0 Congenital Anomalies
9 11 24
44 19.1 Injuries 2
6 16 24 10.4 Other 7
6 17 30 13.0 Total 81
38 111 230
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Logistic Regression Model of Maternal Risk
Factors for Black Fetal and Infant Deaths
Compared to Black Live Births, Kansas City,
Missouri, 1998-2002  
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Logistic Regression Model of Maternal Risk
Factors for Black Sudden Infant Death Syndrome
(SIDS) Compared to Black Live Births, Kansas
City, Missouri, 1998-2002  
 
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Number of Infant Deaths by ZIP Code KCMO 1998-2002
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The Fountain Project Process
Infant Death
Data Gathering
Interview and Record Abstraction
Statistical Analysis
Community Action Team
Case Review Team
Interventions
Improved Maternal and Child Health Outcomes
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The Fountain Project Process
Infant Death
Data Gathering
Interview and Record Abstraction
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The Fountain Project Process
Infant Death
Data Gathering
Other Qualitative Data Methods
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The Fountain Project Process

• Discussion between the team members of the Case
  Review and Community Action Teams
• Participant Observation in your local CHC or
  Neonatal Intensive Care Unit
• Expanding intake forms to include open-ended
  questions about quality assurance
• Systematic interview of clinical and social
  service providers, as well as city government
  officials
• Chart Review from mental health providers
• Ride-Along with the Police Department
• Observation in the local Coroners Office

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The Fountain Project Process
Infant Death
Data Gathering
Statistical Analysis
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The Fountain Project Process
Infant Death
Statistical Analysis
Other Data Sets
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• Demographic and disease information from the
  Community Health Centers
• Data sets from previous studies done within
  local public hospitals
• Data sets from insurance companies and Medicaid
  providers
• State Data sets on pregnancy related mortality
  and morbidity e.g. PRAMS
• State Data sets from child fatality reviews done
  at the county level
• City police data sets for SIDS and domestic
  violence calls
• Division of Family or Social Services data sets

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VALIDATE Data from several different
sources EVERYONE in the System is a source of
information about the system, as well as a
resource for change within the system

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What we found in our process

• Domestic Violence played a role in a majority of
  our cases
• Prenatal Clinic providers often dont refer to
• Case Management Programs (Such as Healthy
  Start), Domestic Violence Shelters, WIC,
  Medicaid Providers, mental health services and
  bereavement programs (Where Available)
• Our federally qualified health centers do not
  make prenatal care records available to all of
  the delivery facilities
• Follow-up Bereavement support is limited for
  women in hospitals without SHARE or Bereavement
  Programs
• Women in Missouri lose their Medicaid coverage
  after their babies are born, putting the primary,
  and many times only, caregiver at medical risk
• There is no risk assessment for previous
  pregnancy loss in the prenatal clinics of many
  health centers, particularly when women call for
  their initial appointment.

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Ivanhoe Community Profile

• Contains three of the five targeted area zip
  codes

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• Has a population of about 12,000 people, of
  which most are African American

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• Household income varies, but average annual
  earnings are within 3,000 of the national
  poverty level of 16,000 a year.

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• Most residents have less than 12 years of
  education and do not own their own homes.

Only half of the 5,000 housing units are owner
occupied
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Children under the age of 17 make up 32 of the
population
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80 of the single parent households in the
Kansas City, Missouri area are located in
Ivanhoe. Many of these residents are
grandparents who are raising grandchildren.
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Preconceptual Health Center Organization
Most of the risk involved for the women in the
target zip codes is SOCIAL rather than MEDICAL
This model contains 60 social and educational
services and 40 medical services
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The Womens and Childrens Wellness Center

• SOCIAL Services would include
• a Healthy Start or Olds Program Site
• WIC services
• Domestic Violence Screening and referral
• SIDS Resources
• Le Leche League Peer Counselor Support
• Housing Assistance
• Fathering Program
• Preventive Medicine Office - Smoking Cessation
  and
• Folic Acid Supplementation

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The Womens and Childrens Wellness Center

• CLINICAL Services would include
• Pregnancy and STD testing
• Breast and cervical cancer screening
• Pre- and Post-natal care
• Comprehensive infection screening and treatment
• Family planning
• Lactation support
• Dental screening and treatment
• Birth Center services.

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The Womens and Childrens Wellness Center

• Educational Services would include
• GED classes
• Clinical Nursing Assistant and Clerical
  training classes
• Job Readiness Training.

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For Further Information Betty E. Cook,
MA Research Associate Department of Preventive
Medicine 816-460-0516 bcook_at_kcumb.edu Dr. V.
James Guillory, D.O. MPH FACPM Associate Dean,
Division of Research Associate Professor and
Chair, Preventive Medicine 816-283-2283 jguillory_at_
kcumb.edu Kansas City University of Medicine and
Biosciences 1750 Independence Ave. Kansas City,
MO 64106

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For Further Information Airick Leonard West 4741
Central 121 Kansas City, MO 64112 (913)
481-7779 airick_at_airick.com