Date of Conferral

2015

Degree

Doctor of Nursing Practice (DNP)

School

Health Services

Advisor

Dr. Mary Beth Stepans

Abstract

Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancyTM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancyTM program implementation plan, customized to meet the needs of a multisite urban hospital system, was coordinated with the Centering Healthcare Institute to ensure method fidelity while allowing for an individual site's needs based upon patient demographics and provider mix. Program evaluation showed that the logic models supported implementation and expansion of Centering Groups at 2 federally qualified health centers, with adequate progress toward site approval, method fidelity scores, and favorable patient and staff satisfaction ratings using the CenteringCountsTM data collection system. After a total of 4 Centering group cohorts with 26 women, 7 at high medical risk, 4 delivered preterm (11.5%), 2.3% less than the institutional average PTB rate of 13.8%. One out of 26 women delivered a LBW infant. Twenty-two of 24 women (92%) initiated breastfeeding compared to the institutional average of 89%. To foster a change in policy toward Centering as the default option for prenatal care, ongoing evaluation is required to assess the reduction of and fiscal impact on preterm and low birthweight rates to offset the cost of implementation.

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