Pregnant woman

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A pilot in-home nurse visit initiative, patterned after a Forsyth Medical Center program, is being rolled out in two counties for first-time mothers and women who are having high-risk pregnancies.

Cleveland County and a yet-to-be-identified county will begin the one-year Medicaid and N.C. Health Choice pilots July 1.

The programs will use state dollars “to provide an analysis of the fiscal impacts of enhanced Medicaid coverage for home visits.”

The goal with the state law, passed in 2017, is determining whether in-home nurse visits help to reduce infant mortality rates, improve infant care and produce cost savings to the state’s Medicaid and N.C. Health Choice programs.

The Cleveland pilot involves the nurse in-home model for women preparing to give birth for the first time, while the other county will use a hybrid model focused on “highest risk” pregnancies for all eligible women. Both programs have a goal of serving at least 100 mothers and their child.

The state had 873 infant deaths in 2016, or 7.2 deaths per 1,000 live births. That was down from 884 deaths, or 7.3 deaths per 1,000 live births, in 2015. Forsyth County had 42 infant deaths in 2016.

The infant mortality rate is impacted by a wide range of factors, including tobacco use and substance use disorders, obesity, domestic violence, poverty, racism, education and access to pre-conception and prenatal healthcare.

The Forsyth Connects program, offered in collaboration with the Kate B. Reynolds Charitable Trust, debuted in May 2016.

It is available for free only to mothers with newborns who are born and reside in the county. The baby doesn’t have to be the mother’s first. Durham County has a similar program.

“If new moms are dealing with postpartum depression or don’t have access to a crib, or are unsure about how they’ll make ends meet with a new baby, the nurse can link that mom to other agencies and resources that can help,” said Kirsten Royster, vice president of the Maya Angelou Women’s Health and Wellness Center at Forsyth Medical Center.

The trust is providing $1.7 million over three years toward the program as an extension of its Great Expectations initiative that is focused on financially disadvantaged young children.

The groups project that of the average 4,500 births in Forsyth each year that about 80 percent of mothers, or 3,600, will accept the in-home service.

Forsyth is providing up to 10 full-time nurses who will make visits to mothers within two to three weeks of the mothers giving birth. The number of projected visits per mother will be between four and seven over an 18-month period.

Cleveland has a similar nurse in-home program funded currently through private grants, while the other county does not have a nurse in-home initiative.

Nurses will observe the health of the mother and recommend community resources that can help.

Nurses participating in the Cleveland pilot would make up to 58 visits.

The visits would take place weekly in the first month following enrollment during the pregnancy, then every two weeks until the child is born.

After birth, the visits will be conducted weekly for the child’s first six weeks after birth, every other week until the child becomes 21 months old, and then monthly until the child turns 2.

For the highest risk pregnancies pilot, there would be up to 10 in-home visits. They will take place during the pregnancy, initially weekly after birth, followed by every four weeks through the first 46 weeks after birth.

DHHS estimated the per-visit cost at $83.72 with a projected expense of $251,160 in Cleveland when counting the salaries of two state nurse consultants, and $92,092 in the other county.

State health officials estimate that if the nurse in-home visit program were to be expanded statewide, it would require dedicating 680 registered nurses and 85 master’s prepared registered nurse supervisors to assist with 17,000 first-time mothers annually.

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