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(L to R) Pictured is the leadership team for the Safe Babies Safe Moms program: Neil Weissman, MD, Chief Scientific Officer, MedStar Health; Tamika Auguste, MD, interim chair, Women’s & Infants’ Services; Angela Thomas, DrPh, MPH, MBA, assistant vice president, Healthcare Delivery Research, MedStar Health Research Institute; Loral Patchen, PhD, CNM, clinical project lead and director, Advanced Practice Providers, Women’s & Infants’ Services; and Chief Medical Officer Jeffrey Dubin, MD, MBA.
Imagine reducing infant mortality rates by as much as 30 percent in five years, so the District of Columbia becomes known as having the most effective infant mortality reduction program in the nation, rather than the current state, where we stand as among the highest rates of infant death. Imagine we can accomplish this phenomenal transformation by creating new relationships that support individuals’ health through to adulthood, throughout all aspects of our community, without limitation by race or ethnicity, and one that translates on into the next generation.
Thanks to a landmark endowment from the A. James & Alice B. Clark Foundation, MedStar Health is poised to change the face of maternal/infant health in the nation’s capital. Called Safe Babies Safe Moms (SBSM), the effort brings together experts in women’s health, family medicine, behavioral health, and pediatrics, at both MedStar Washington Hospital Center and MedStar Georgetown University Hospital. The Clark Foundation has allocated $27 million—the largest philanthropic donation in MedStar history—supplemented by an additional $3 million from MedStar Health, to move the needle decidedly in a positive direction.
“We at MedStar and the Hospital Center’s Women’s and Infants’ Services are fortunate to receive this gift from the Clark Foundation,” says Tamika Auguste, MD, interim chair, Women’s and Infants’ Services (WIS). “This extraordinary gift will enable us to do the work to improve the birthing experience, maternal, and infant mortality in the District of Columbia. We have the drive, the innovation, and now the resources. We will not only take care of the women here at the hospital, but also work with our community partners, to ensure our mothers and babies thrive. This will ensure lasting excellence in maternal and infant care for years to come.”
The five-year program went live Nov. 1, welcoming its first patients, with plans to serve some 3,600 women who deliver each year at the Hospital Center. Women can enter the program at any point—pre-pregnancy, prenatal care, delivery, postpartum/postnatal care, and maternal/infant/family care to age 3.
Loral Patchen, PhD, CNM, is the clinical lead for the hospital’s WIS portion of SBSM. “Our goal is to provide maternity care that women describe as respectful of who they are as people and was delivered by a team that took their concerns seriously, listened to what was important to them, and provided the information they needed to make the best decisions for themselves and their baby.”
The genesis of the program is the dismal statistics for infant and pregnancy-related mortality in the District, which are higher than the national average. Looking closer, infant mortality is almost four times higher for Black mothers. Black women are three times as likely to die of pregnancy-related causes when compared to White women.
SBSM is part of MedStar Health’s vision of advancing health through lifelong care, delivered at each stage of life, and incorporating best practices imbedded into the community. “There are opportunities for all of us to improve across all aspects of care,” says Jeffrey Dubin, MD, MBA, Chief Medical Officer. “We’ll find what gaps there are in performance, and close those gaps.”
“As an academic health system, we live at the crossroads of academics with real world medicine, which gives us an opportunity to bring the best and brightest to the delivery of care in our community,” says Neil Weissman, MD, Chief Scientific Officer for MedStar Health. “Medicine tends to be reactive when someone gets sick, while health is proactive, in preventing medical problems. This program focuses on advancing the health of babies and moms, by preventing complications during pregnancy. This is the future of care that focuses on health.”
Reinforcing cultural sensitivity
Because SBSM is based in the District, which has a large Black community, it is imperative that caregivers are sensitized to the needs of city residents, says Angela Thomas, DrPH, executive lead for the program. “We need to address the clinical, environmental, social, and health system risk factors our families face,” she says. “We are looking to reach women where they live and work, with programs that address their individual circumstances. We need to address systemic racism within health care.”
“Our current health structure is riddled with historic and cultural inequities,” Dr. Patchen adds. “To change care delivery, we have to adopt an anti-racist approach. We need to rise to that level of intentionality.”
Identifying risk factors
Work is underway to identify the risk factors associated with poor outcomes for mothers and infants. For mothers, many of those risk factors—hypertension, diabetes, obesity—are part of the medical record. Other parameters are more difficult to identify—for example, family support, adequate nutrition, and access to transportation.
An interdisciplinary approach to identify all the factors associated with poor outcomes is ongoing, aiming to target ways to improve outcomes at each step. “When we identify these factors, we can provide interventions tailored to women’s needs,” Dr. Thomas says.
SBSM participants will have access to health care and community resources, geared to support efforts to establish healthier patterns. “Working with outside resources, SBSM is building bridges into the community,” Dr. Thomas explains. “Community of Hope provides services for families in need, including health care, housing service, and workforce development. Mamatoto Village creates career pathways for Black women, provides perinatal support for maternity care, along with information that supports parenting and daily living requirements. A partnership with the Health Justice Alliance adds medical/legal services.”
Integrating multi-generational care
Integration of services across the healthcare spectrum, including the integration of pediatric and mental health services, is key to the program’s success.
Accordingly, SBSM establishes links among hospital programs, which too often operate in silos, Dr. Thomas notes. “We are co-locating services and addressing transportation when needed. Patient navigators are the glue that holds the initiative together. Accordingly, the program is recruiting women with a shared living experience, to assist SBSM participants in navigating the system.”
“Our goal is alignment, not duplication of services,” Dr. Patchen says. “We need a comprehensive approach, from the front desk to the bedside.”
A critical component of SBSM’s success is the ability to measure results. Under the guidance of MHRI, statistical analysis will assess progress and fine-tune evidence-based initiatives.
“In five years, we hope to move the numbers, with a 25 to 30 percent reduction in infant mortality,” Dr. Weissman says. “Five years after that, we hope there is a full reversal, and we are among the best in the country for infant mortality. We want the District to be held up, as the place that provides great care for moms and babies.”
“If it was simple, it would have been done already,” Dr. Thomas adds. “But it’s complex, so we’re rolling up our sleeves. We will crack that nut.”