Data to Action Success Story: West Virginia
West Virginia has the highest proportion of pregnant smokers in the nation. According to Vital Statistics and PRAMS data, about 30% of West Virginia (WV) mothers smoke during their pregnancy. This rate is nearly three times the national average, and is well above the Healthy People 2020 target of <1%. In addition to the tobacco use-related health risks for the general population, pregnant women face additional risks. Pregnant smokers are more likely to have miscarriages, stillbirths, preterm labor, and premature babies than pregnant nonsmokers. Additionally, babies born to mothers who smoked during pregnancy may be born with low birth weight, and are at greater risk for sudden infant death syndrome (SIDS) compared with children of mothers who did not smoke in pregnancy.
Program Activity Description
The WV Division of Tobacco Prevention (DTP) Cessation Program and the WV Office of Maternal, Child, and Family Health, in conjunction with their media company, determined that WV needed a media campaign targeted toward pregnant smokers and all women of childbearing age. Using findings from analyses of data from WV PRAMS and WV vital statistics, DTP and the media company designed the Tobacco-Free Pregnancy Initiative of West Virginia media campaign.
The goals of the initiative were to educate women of childbearing age and those who are pregnant on the dangers of using tobacco; reduce the prevalence of tobacco use among pregnant women; encourage collaboration with health care entities to support tobacco cessation services; educate health care providers on counseling pregnant women about tobacco cessation; promote the use of the existing WV Tobacco Quitline by pregnant smokers and their families; and recruit community and statewide champions.
A press conference held in the governor’s office in March 2009 officially kicked off the program. Governor Joe Manchin introduced the Tobacco-Free Pregnancy Initiative of West Virginia to community collaborators, members of the legislature, and public health leadership, and unveiled the advertisements. After this event, DTP began the media campaign, which included television, radio, print, and billboard advertisements. The WV Tobacco Quitline offered enhanced services for pregnant callers and their families. Enhanced services included giving pregnant enrollees priority for coaching services, allowing them unlimited enrollment for full services using specialized materials tailored toward pregnant smokers, and granting eligibility for the full range of Quitline services to anyone living with a pregnant woman. In addition, a member of WV DTP was invited to present at the National Conference on Tobacco or Health and the North American Quitline Consortium Conference, garnering national attention for the initiative. DTP established partnerships with Women’s and Children’s Hospital (one of the state’s largest birthing facilities), Marshall University School of Medicine, and WV Healthcare Education Foundation to offer educational and training programs for pregnant women and health care providers. Lastly, DTP announced the availability of community grants for programs that offered pregnant smokers one of the following services: face-to-face tobacco cessation interventions, cessation classes, or education about secondhand smoke.
Program Activity Outcomes
In the first 6 weeks of the media campaign, the WV Tobacco Quitline received 2,355 calls. Five hundred callers enrolled in a tobacco cessation program, 48% of whom learned of the quitline through the media campaign. Approximately 100 of these new enrollees were pregnant women or their family members who wanted to quit smoking.
In addition to the other DTP services that were being offered in tandem with the media campaign, Women’s and Children’s Hospital began offering the program Tobacco Free for Baby and Me at a clinic serving women with high-risk pregnancies. Marshall University School of Medicine began offering free training to health care providers on how to conduct face-to-face tobacco cessation counseling with pregnant women and women of childbearing age. The Healthcare Education Foundation started offering the Day One program—a secondhand smoke education program—to new parents in the hospitals before the newborns go home. They also created the educational Day One DVD to distribute to hospitals and birthing centers throughout the state. In May 2013, DTP hosted focus groups with individuals from the health department and other health professional to review plan for future activities related to prenatal tobacco cessation initiatives in West Virginia.
Gestational Diabetes Mellitus (GDM) is a disease in which women, who have no history of diabetes, develop hyperglycemia during pregnancy. Gestational diabetes may present with only a few symptoms, and because of this, the disease may go undiagnosed. Often times, GDM is detected by screening pregnant women for the disease. About 3%–5% of pregnant women will develop GDM. Early detection and proper care is crucial, because uncontrolled GDM can lead to pregnancy complications that can affect both mother and baby. These complications include macrosomia (or a large infant), infant jaundice (yellowing of the skin or the whites of the eyes), an increased risk of maternal high blood pressure causing preeclampsia(a pregnancy complication often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, or multiple organ failure), and recurrent GDM during future pregnancies. In patients with GDM, elevated glucose levels return to normal after pregnancy. However, women with GDM are more likely to develop type 2 diabetes later in life. For this reason, women who have had GDM need to receive postpartum screening (even among those women whose glucose levels have returned to normal). Gestational diabetes is a growing concern in West Virginia (WV).
Program Activity Description
In an effort to improve the quality of care for WV women who may develop GDM, several state agencies and stakeholders are collaborating to design a project to identify strengths and weaknesses in the GDM care process. The project, Gestational Diabetes: Better Data, Better Care, has been conducted in phases. Phase 1 (2008–2009) focused on data validation and comparisons from various sources (e.g., PRAMS, birth certificate, hospital charts, records). The findings indicated GDM follow-up procedures needed to improve during prenatal and postpartum (after birth) care; and data quality was lacking because of failure of thorough medical documentation. Phase 2 began in 2010 and used the finding of the first phase to implement a plan of action to improve quality of care and data accuracy at one of West Virginia’s largest birthing hospitals. The hospital created a team of several health care professionals who established hospital procedures and policy changes that address the following goals: (1) establish a standard of performance to improve screening for GDM, (2) improve documentation, (3) strengthen patient education, and (4) improve postpartum care. Phase 3 will add missing information.
Program Activity Outcomes
In 2011, one year after implementing these goals and changes, data showed that more women received prenatal screening, and the medical records indicated better documentation of GDM. For example, the first year of collected data showed the number of patients who failed the 1-hour glucose test remained at 18%, but the number of patients who were in compliance with a 3-hour follow-up test increased from 55% to 72%. Results also showed that 100% of patients who were identified by this program had the correct data collection forms and correctly documented diagnosis of GDM in their charts and record. In 2012, the team also implemented an incentive program that is now used to encourage follow-up care compliance. This program provides women with various gifts, such as department store gift cards for continuing follow-up care. In addition, women are educated about the importance of follow-up care, and discharge orders automatically document follow-up visits. The project will expand collaborative efforts between West Virginia health care providers, policy leaders, and other stakeholders. The pilot program will be implemented in other hospitals within the state. Researchers also will review the data sources to determine if documentation and data quality have improved.