MAMA's Risk Stratified, Prenatal Medical Home Model Reduces Preterm Birth for African Americans in LA [22N

Abstract

INTRODUCTION: MAMA'S Neighborhood (MAMA's) in LA County (LAC) organizes prenatal care into a medical home model of wrap-around services. African American (AA) women are 48% more likely to experience PTB than non-Hispanic whites and experience myriad social stressors; MAMA's was designed to support women experiencing such stressors to reduce PTB risk. MAMA's implemented risk assessments at intake for behavioral health, substance use, housing/food insecurity and medical risk; and stratified risk groups to direct levels of care management and services to address these risks. METHODS: This is a retrospective cohort study, using single site data from a national demonstration project, to compare PTB rates for women in LAC during two phases: Phase 1: January 2014-August 2015, MAMA's introduced a novel risk assessment for social stressors and Phase 2: September 2015-December 2016, implemented risk-stratified population health management and individualized care planning. Multiple births were excluded. Multivariate logistic regression was performed and controlled for: medical comorbidities, smoking, race/ethnicity, age and prior PTB. RESULTS: Phase 1 included 441 women, compared to 435 in Phase 2. PTB among AA women dropped from 18% in Phase 1 to 9% in Phase 2. Regression reveals PTB among AA women was reduced when compared to controls with an adjusted odds ratio of 0.21 (CI 0.062-0.708), p<0.02. CONCLUSION: MAMA's made a clinically and statistically significant impact on PTB for AA women, a critical step in addressing the health equity gap. MAMA's represents a promising value-based strategy leveraging multidisciplinary collaborative care with existing social services in the safety net to improve birth outcomes.