An innovative program that delivers community-based health care to new mothers in ethnic or socioeconomic groups at higher risk for health care complications has been recognized by the Department of Health and Human Services (HHS) for improving access to postpartum care.

The Extending Maternal Care After Pregnancy (eMCAP) program received an HHS Racial Equity in Postpartum Care Challenge award. In July, the program that provides services to women in southern Dallas County with limited access to regular hospital- or clinic-based locations was named one of 25 winners of phase 1 of the overall $1.8 million national competition.

The contest, which includes a $40,000 award, identifies innovative methods to improve equity of postpartum care for Black and American Indian/Alaska Native beneficiaries enrolled in Medicaid or the Children’s Health Insurance Program. The winning organizations demonstrated success in addressing equity during the postpartum period with an emphasis on follow-up care for diabetes, postpartum depression and/or anxiety, hypertension, and substance use disorders.

David B. Nelson, M.D.

The eMCAP program has improved health care using evidence-based approaches to target gaps in screening and to increase access for patients to follow-up maternal care, said David B. Nelson, M.D., Associate Professor of Obstetrics and Gynecology, who leads the unique program that his team launched in 2020. To date, the program has served at least 2,200 new mothers.

“Being a part of this program significantly increased follow-up for patients with hypertension and diabetes up to 12 months after birth,” Dr. Nelson said.

The program has also led to improvements in treatment for behavioral health issues.

“We know that after they give birth, patients are at risk for anxiety and depression,” Dr. Nelson said. “So we didn’t just screen for that but successfully referred patients to counselors, made sure they made it to follow-up visits, and had mental health care access.”

Services were added that enhanced access to postpartum care, including visits from community health workers or nurses, mobile clinics, and virtual visits. By extending the time that women receive care after delivery from 60 days to a year, the program has had a significant positive impact on women’s health.

Home blood pressure cuffs help patients monitor their hypertension. Screening and referrals for perinatal mental health and substance use disorders also are provided.

Program participants may receive care in their neighborhood from providers who come to them via a mobile care unit.

One aspect of the program involves reaching out to the community with culturally and linguistically appropriate services. Receiving patient feedback for improvement has been an emphasis, Dr. Nelson said.

The overarching hope is that the program will address maternal mortality. The postpartum period – rather than delivery – is considered the time of highest risk for maternal morbidity and mortality, Dr. Nelson said. Women with limited access to care for conditions such as hypertension and diabetes are especially at risk.

“The United States is facing a maternal health crisis,” Dr. Nelson said. “There are more than 700 women who die each year, and that burden is not shared equally. Pregnant patients of color have significantly higher rates of death.”

The program at Parkland, provided in partnership with UTSW physicians and other caregivers in obstetrics and gynecology, could one day change the way postpartum care is provided, he said.

“This program replaces the postpartum care model that patients receive, which is really meaningful,” Dr. Nelson said. “Our goal is to continue to grow the program in services and scope.”