Improved health of rural Kansas moms and babies is program's goal
September 16, 2015
By Brian Whepley
Women in far western Kansas often travel a long way from home to deliver their babies at Kearny County Hospital in Lakin, and one in nine carry a potentially dangerous complication - gestational diabetes - along with them.
Doctors at the hospital about 25 miles west of Garden City deliver babies from 12 counties, and the critical access facility has steadily bolstered its obstetrics capabilities. One way it's done that is with a partnership begun nearly two years ago between KU School of Medicine-Wichita and the hospital, called Pioneer Baby - a program to improve pregnancy and birth outcomes.
The partnership, with the key involvement of Lisette Jacobson, assistant professor of preventive medicine and public health, started with Jacobson's work on a Children's Miracle Network grant to buy equipment for better obstetrical care. It has continued by assessing the extent of the region's gestational diabetes problem. It now involves direct treatment by a specialist, and a prevention program.
High rates of diabetes put moms, babies at risk
The numbers in Jacobson's research reveal the challenge providers and patients face. About 11 percent of women who deliver at the Lakin hospital have gestational diabetes, a number that is as much as twice the national average.
"Eleven percent in a rural area, that's high," Jacobson said. "It's a number you don't want to have."
Benjamin Anderson, CEO of Kearny County Hospital, said the hospital provides a level of obstetrical care that is critically needed, so "we need to have the tools to do it well." Addressing gestational diabetes is one way of doing that.
Pioneer Baby has grown to include Garden City-based United Methodist Mexican-American Ministries' (UMMAM) clinics, where John Birky, a graduate of KU School of Medicine-Wichita, is medical director, and Scott County Hospital in Scott City. Birky previously worked at the Lakin hospital, which also has strong ties to KU School of Medicine and Wichita. Family practitioners Drew Miller and Arlo Reimer are KU graduates, and Birky and Drs. Lisa Gilbert, Lane Olson and Jonathan Peters all went through one of the Wichita campus' family medicine residency programs.
Jacobson's assessment found that more than half of the women with gestational diabetes were young, Hispanic, low income and had not gone beyond high school. More than 75 percent were overweight or obese, and one-third had an immediate family member with heart problems or diabetes. All are risk factors for pregnancy complications and often correlate with a higher chance of developing gestational diabetes during pregnancy.
"Women in rural areas are already at a disadvantage because of access to delivery of health care in rural areas," Jacobson said. "Many times there's no obstetrician or gynecologist, and women in rural areas tend to get prenatal care later in pregnancy."
For babies, complications of gestational diabetes include excessive birth weight, respiratory problems due to early delivery, low blood sugar and a higher risk of developing type 2 diabetes. Mothers also have a higher likelihood of type 2 diabetes later in life and a greater risk of high blood pressure and life-threatening preeclampsia during pregnancy.
Effective intervention is complex
Birky said UMMAM, a federally qualified health center, sees many patients with gestational diabetes. Addressing obesity, lack of exercise, and other lifestyle habits that contribute to diabetes isn't easy, because they involve so many factors, including cultural and family norms and access to affordable healthy food.
"There are multiple influences that all go into the end result of a baby born with malformations or long-lasting physical effects," Birky said. "The best thing is to prevent it before it affects the baby in the first place."
The Pioneer Baby initiative has four phases. The first, an assessment of needs, is complete. The second phase is to bring specialized care for mothers-to-be and new mothers to the region. That began in late August, when Wichita maternal and fetal medicine specialist Michael Wolfe made the first of what will be monthly visits to Lakin to run a clinic for women with or at high risk of pregnancy complications.
Finding what works
Like other parts of the venture, bringing Wolfe to Lakin is a cooperative venture. Anderson recruited the doctor, Children's Miracle Network is covering the cost of the monthly flight, and a host of Kearny County banks, other businesses, and a foundation donated money to buy the 4D ultrasound machine required. "This required a significant piece of equipment," Anderson said. "The large employers really kicked in."
Jacobson is about to begin the third phase, conducting six focus groups of six to eight women each, who will or should be taking part in the prevention program. The sessions are intended to determine ways that could effectively combat gestational diabetes. The prevention plan will be designed around the input gathered from the women in the focus groups.
"I want their buy-in, and that comes with ownership," Jacobson said. "What we're trying to find out with these focus groups is what they would value in a program. What will help them?"
After gathering the women's input, Jacobson intends to seek a federal grant for Pioneer Baby's final phase: a health promotion program to lower gestational diabetes and reduce related pregnancy complications. She expects it will include efforts to increase exercise and reduce obesity but would undoubtedly include other elements developed via the focus groups. Other interventions she's studied haven't focused on women in rural areas.
UMMAM has a diabetes educator on staff, along with a nurse practitioner who is obtaining specialized training in diabetes. The clinic hopes to contribute insights and interventions to Pioneer Baby.
"We all know that prevention is better than the cure, and the hope is that through the program we are developing we can show what works," Birky said.
Medical school and partners collaborate to find solutions
"What makes this project so unique is we've created this collaborative network that includes public health, the KU School of Medicine-Wichita, critical access hospitals, and federally qualified health centers such as UMMAM," Jacobson said. "We are putting a new model of care in place, and put Kansas on the map for other states with a rural population to emulate."
Jacobson has broad backing. "I have the full support from KU here in Wichita. Not just the support of my chair, Tracie Collins, but also from the Department of Family and Community Medicine with Rick Kellerman and David Grainger, the chair of OB-GYN. The enthusiasm of our colleagues in western Kansas makes the work so much easier."
"Several physicians over at UMMAM and Kearny County Hospital just can't wait to be involved in this," she said. "We're all committed to improving the health of western Kansas women and their babies."KU School of Medicine-Wichita