TRANSICIONES

CenteringPregnancy (CP) is an evidence-based model of GPNC that has been associated with improved maternal and child health outcomes and reduced maternal and child health disparities (Grady & Bloom, 2004; Heberlein et al., 2015; Ickovics et al., 2003, 2007; Picklesimer, Billings, Hale, Blackhurst, & Covington-Kolb, 2012). The model is supported by the Centering Healthcare Institute (CHI) and based in Boston, Massachusetts. CHI is a nonprofit organization that provides the expertise, training and tools necessary to start and sustain Centering group care practice. There are three key components to the CP model of care: 1) Healthcare check-ups by a licensed clinical care provider during group time in a private corner in the same group space, as well as patient self-careactivities to assess their own blood pressure, weight, and body mass index. 2)

Educational content is provided through group facilitation, rather than taught in a didactic manner by two trained facilitators.3) Women are provided support through

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relationships among group members and interactions with facilitators (Rising et al., 2004).

CenteringPregnancy was initiated in South Carolina in 2008 at Greenville Health System in Greenville, SC, through support from the March of Dimes, and independently at Mountainview Ob-Gyn in Easley, SC the same year. Greenville Health System

reported a 47% reduction in the odds of preterm birth for women in CP in a retrospective cohort study published in 2012 (Picklesimer et al., 2012). Given the impact of CP on birth outcomes, shown through research at Greenville Health System and other sites in the United States, in 2012 the South Carolina Birth Outcomes Initiative proposed expanding access to CP as a core strategy to improve birth outcomes in SC. In January 2013, the South Carolina Department of Health and Human Services (SC DHHS) began to invest in its expansion to sites throughout the state.

Dr. Amy Picklesimer, a Maternal-Fetal Medicine specialist with the Greenville Health System was selected to oversee the SC DHHS CP expansion. Greenville Health System was selected because their practice runs one of the largest and most successful CP practices in the country, and Dr. Picklesimer was already working with the South

Carolina Chapter of the March of Dimes on a similar statewide expansion project for CP. A “start-up package” was created for each new practice, which included 1) training for providers and staff in the CP model, 2) a contract with CHI for a Model Implementation Seminar and practice support through the site approval process and 3) a small budget to cover any necessities for running groups and outfitting the group space, such as patient notebooks, snacks, blood pressure cuffs, chairs or other educational materials.

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Concurrently, SC DHHS made incentive payments available through the Medicaid Managed Care Organizations for providers using the CP model.

Prior to applying for start-up funding, each practice was required to attend a CHI Model Implementation Seminar, which proved to be a vital space for garnering

stakeholder support. Model Implementation Seminars were held in November 2012 and November 2013, and November 2014. Through the seminars, stakeholders from multiple obstetrical practices with expressed interest in starting up CP gathered to talk about the process. These seminars were facilitated by an experienced CHI faculty member and by the State CP coordination team. During the daylong session, participants had the opportunity to learn more about CP, meet faculty from CHI, hear from providers from sites in South Carolina that have successfully implemented CP, and ask questions.

Expansion sites were selected through a competitive application process. After the Model Implementation Seminar, sites were invited to submit an application. Applications were reviewed by a committee, which included representation from SC DHHS, South Carolina March of Dimes, CHI, the Greenville Health System team, and members of this process evaluation committee. Practices were selected based on scores generated from the CHI “site readiness tool,” which include number of OB patients, available physical space that could be used for groups, and support for model implementation from practice leaders. Additional criteria generated by the SC team included percent Medicaid patients in each practice. Since 2013, there have been three Model Implementation Seminars, followed by open periods for practices to apply for start-up. Fifteen practices attended the first two Model Implementation Seminars. Seven clinical sites throughout the state have been selected by the application committee and trained by CHI to offer CP prenatal care.

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Between 2013 and 2014, all seven of the sites began to offer GPNC, following the CP model, as an option to women seeking prenatal care. The final three sites were notified in 2015 that they have been selected to implement CP.

Each site has trained facilitators comprised of a licensed care provider (physician, nurse practitioner or nurse midwife) and a co-facilitator who is often a nurse or support staff member. Steering committees were convened at each of the CP sites and include positions such as: group facilitators, other healthcare practitioners, center director, clinic coordinator, other clinic administration, marketing leader, internal process evaluation and benchmarking leader, support staff, and patients. All of the sites meet regularly with the Statewide CP Coordinator through SC Centering Consortium meetings.