1. MPP
1.1. PNC
1.1.1. 67% 1st trimester
1.1.2. 3% 2nd trimester
1.1.3. 23% 3rd trimester
1.2. Births
1.2.1. 2009: 98
1.2.2. 2010: 126
1.2.3. 2011: 23
1.3. 2011 Participants
1.3.1. 54 left before delivery
1.3.2. 28 with unknown status
1.4. Retention Strategies
1.4.1. Make it about "program" not "worker"
1.4.1.1. Peer Group Attachments for Retention
1.4.1.2. Staff Personal Bios
1.4.1.3. Staff Photos
1.4.2. "Centering Pregnancy" Model
1.4.2.1. South Community Birth Program
1.4.2.1.1. 35-minute DVD
1.4.2.2. Kokua Kalihi Valley
1.4.2.2.1. Lois Arakaki
2. Associating LAC Activities with MPP Priorities
2.1. Helpful for LAC members to understand purpose of LAC: MPP & Target population
2.2. MPP Staff input
2.2.1. December 5 @ 10:00am (Waimea)
2.2.1.1. Eric to attend to get input
2.2.1.2. Eric & Grace to connect & prepare
3. Local Health System Discussions
3.1. West Hawaii
3.1.1. OB Shortage
3.1.1.1. Dr. Sira nearing retirement (~80 yo?)
3.1.1.2. Dr. Ruiz Closing Jan 2012
3.1.1.2.1. Half of births at KCH
3.1.1.2.2. $50 per PNC visit
3.1.1.2.3. Spanish speaking
3.1.1.2.4. January 2012: 2 births w/o PNC
3.1.1.3. Letter of Concern
3.1.1.3.1. Drafted by Barbara Choy & Sharon Bechler
3.1.1.3.2. Signed by Charlene Taketa for WHI LAC
3.1.1.3.3. Declining # OB accepting Quest
3.1.1.4. Investigating how WHI CHC to fill in gaps
3.1.1.4.1. KCH Privileges
3.1.1.5. We're seeing more moms with no prenatal care
3.1.1.6. Task Force Access to Care (incl WHI CHC)
3.1.2. Kona Community Hospital
3.1.2.1. No Midwife privileges
3.1.2.2. No Family Practitioner privileges
3.1.3. 30% WHI MPP clients cash-pay (no insurance)
3.1.3.1. EHI MPP Clients: 90% Quest
3.1.3.2. NHI MPP Clients: 87% Quest
3.2. Statewide Discussions on workforce shortage
3.2.1. Perinatal Advocacy Network statewide VCC
3.2.1.1. Sen. Green suggested partnering with insurance companies
3.2.1.2. Dr. Sakamoto Study on Rural Health Workforce Shortage
3.3. East Hawaii
3.3.1. Have Bay Clinic CHC
4. PNC Issues
4.1. Advocacy
4.1.1. This grant allows for it
4.1.1.1. Continuation: due Dec 19
4.1.2. Fact Sheet
4.1.3. Newspaper article
4.1.4. Forum on "Access Issues & Healthy Outcomes"
4.2. Statewide
4.2.1. Upcoming DHS Cuts
4.2.2. Revisit of COFA & Hawaii impact
4.3. Hawaii Island PNC Access
4.3.1. OB Shortage
4.3.2. 70% "less than adequate PNC" (PRAMS)
4.3.3. Quest acceptance
4.3.4. Cash-pay Costs
4.3.4.1. Global coverage $2200-$2400
4.3.4.2. Dr. Ruiz $50
4.3.4.3. Undocumented / uninsured
4.3.5. Hospital Privileges
4.3.5.1. KCH
4.3.5.1.1. Not Midwives
4.3.5.1.2. Not Family Practitioners
4.3.5.2. HMC
4.3.5.2.1. Dr. Bucci, FMP
4.3.6. Midwives to fill gaps
4.3.6.1. No State Licensure
4.3.6.2. Not hospitable climate
4.4. Access vs. Quality of PNC
4.4.1. Universal Access will make greater difference with High Risk pregnancies
4.4.2. Access may not make significant difference with Normal pregnancies
4.4.3. Type of PNC may make more noticeable difference than increased Access