P3B237: Healthy Mom, Healthy Family: Incorporating Interconception Care into Well-child Visits

Purpose/Objectives: Ohio has one of the highest, most racially disparate infant mortality rates (IMR) in the United States. Risk factors for infant deaths include short interconception intervals, prenatal tobacco use, and late prenatal care. In response, we created the Healthy Mom, Healthy Family (HMHF) program, modeled after the national IMPLICIT Network. The program’s objective is to incorporate maternal interconception care into well-child visits (WCVs) in pediatric and family medicine office settings to increase primary care provider (PCP) screening and counseling and to encourage maternal behavioral changes.

Design/Methods: Ohio pediatricians and family practitioners, recruited by the Ohio AAP Chapter, self-selected to participate in the first 12-month wave between February 1, 2021 and January 31, 2022. Providers used a standardized paper or electronic data tool to collect information on maternal behaviors related to multivitamin use, depression/anxiety, tobacco use, and birth spacing at 0-18 month WCVs. PCPs used quality improvement methodology to incorporate the tool into WCVs and provide tailored education and counseling to mothers with at-risk screens. Each site implemented three Plan-Do-Study-Act cycles during the project to improve screening and counseling processes. Educational sessions were provided to PCPs throughout the program implementation period. Screening and counseling rates, provider confidence, and patient behaviors were analyzed.

Results:

Results: Nine practices (with 22 providers) completed Wave 1, with 1,536 screens completed. All providers (100%) were frequently screening mothers for symptoms of depression/anxiety both pre-and post-project implementation. Screening for tobacco use increased from 92% to 100%, screening for family planning increased from 85% to 86%, and screening for multivitamin use increased from 62% to 86% by project end. At the end of the wave, the percent of women self-reporting symptoms of postpartum depression/anxiety decreased from 17% to 9%, with referrals for mental health services increasing from 57% to 67%. The percent of women who received referrals for tobacco cessation increased from 86% to 100%, and the percent of women who received education on healthy birth spacing increased from 64% to 73%. Self-reported pre- and post-surveys by providers also showed that providers’ level of comfort for discussing interconception health with the mothers of their patients increased from 92% to 100%.

Conclusion/Discussion: This project demonstrates that pediatricians and family practitioners can successfully incorporate models of care on interconception health into their practices to improve maternal access to care and health risk mitigation. Further work is needed to determine how this model later affects the IMR with this patient population.