North Country Hospital Quality Improvement Project
This is a collaborative project between North Country OB/ GYN Services (a medical practice) and Newport District Office of VT Department of Health (VDH) to promote use of the VDH program entitled Women, Infants and Children (WIC).

Initiated in 2005

Problem Statement
There are low-income population segments that do not have adequate resources for self-care. WIC specifically addresses nutritionally or medically at risk pregnant, postpartum or breastfeeding women, and children younger than 5 years old.
According to VDH, the goal of the WIC program is to improve health by educating families about good health practices and by providing nutritious foods to eligible Vermonters. Every year, thousands of women, infants and children receive health screenings, nutrition assessments and health education from the WIC program.
WIC is designed to serve:

• Income-eligible pregnant or postpartum women who are nutritionally or medically at risk.
• Income-eligible new moms who are breastfeeding and who are nutritionally or medically at risk.
• Income-eligible children, up to age 5, who are nutritionally or medically at risk.
In addition to providing healthy foods such as low-fat milk, juice, cereal, peanut butter, eggs and cheese, WIC gives participants free health and nutrition instruction and puts them in touch with other community resources.

More information about WIC can be accessed at: http://healthvermont.gov/family/wic/whatiswicenglish.pdf

Project Goals
The goal of this project is to increase early enrollment, defined as first trimester, into the WIC program for screening, assessment, and access to preventive care and wellness resources.

The Practice Manager of North Country OB/GYN Services set a goal of increasing enrollment of first trimester pregnancies from 58% to 75% as measured by VDH during 2006.

Intervention
The project began by initiating communication between the VDH Newport District Office and the staff of North Country OB/GYN Services in order to explore ways to work collaboratively in encouraging women to enroll in the WIC program early in their pregnancy, with the goal of improving the rate of early enrollment. It was decided that early enrollment might be improved by allowing patients to schedule a WIC visit in conjunction with an obstetric visit. It was further decided that a mechanism was needed for these synchronized visits to be coordinated from the OB/ GYN practice instead of relying on patients to contact VDH at a separate time. A second meeting of appropriate staff persons from North Country OB/GYN and the Newport District Office resulted in the accomplishment of this task. It was decided that a schedule will be open one morning a week at North Country OB/GYN Services for potential WIC clients to initiate WIC services while being there for their initial pregnancy assessment visit.

A schedule was generated via OB/GYN’s scheduling software for a WIC coordinator to be present on Wednesday mornings. Three appointments are available each Wednesday morning for 1 hour each. North Country OB/GYN is providing space for the WIC coordinator for intake and assessment. Scheduling will continue to be provided by OB/GYN staff.

All involved staff received education regarding this new service and are reminded to offer patients this option. Packets were prepared for patients that include WIC information, an application form and an appointment card.

Evaluation Process
Baseline performance, as measured by VDH, shows a 58% enrollment rate of early pregnancy patients (first trimester) into WIC.

During the first two months, one to two patients per morning were seen. This number has steadily increased.

First quarter result: 70% early enrollment rate
Second quarter result: 68% early enrollment rate

In April, which was during the third quarter, we received notification from VDH that early enrollment in this area has moved from the lowest rate to the highest rate in the state.

A secondary benefit from this project has been improved communication and a better working relationship between the two organizations.

For more information, contact:

Elizabeth Lounsbury, Practice Manager
North Country OB/ GYN Services
81 Medical Village Drive, Suite 2
Newport, VT 05855

Tel: 802.334.4110
Fax: 334.4113
Email: elounsbury@nchsi.org