Expectant mothers on the south and west sides of Columbus, Ohio--particularly teen mothers--were less likely than most to avail themselves of prenatal care, and a 1992 study of babies born at OhioHealth's Grant Medical Center found a correspondingly high rate of babies ending up in the facility's neonatal intensive-care unit.
Perhaps not surprisingly, the infant mortality rate in the two census tracts studied reached as high as 21 per 1,000 births, two to three times the national average.
The combination of high teen-pregnancy rates and a lack of available care nearby led the medical center to bring the care to these mothers--in the form of a semitrailer, outfitted as a seven-room doctor's office, that rolls into 10 area schools.
"We decided a solution might be to take the service to the schools," says David Blom, president and chief executive officer of OhioHealth, who helped launch the Wellness on Wheels effort 12 years ago while serving as executive vice president. "We purchased a tractor-trailer, outfitted it as a clinic, hired a staff, found a physician to sponsor it and then, on a rotating basis, go to the various high schools and treat the teenage girls."
The program, which has expanded to include urgent care, asthma screening and other services, boasts an infant mortality rate of 7.2 per 1,000 births, considerably lower than city and state outcomes for low-income and black neighborhoods, while serving more than 2,000 prenatal patients since 1993.
For these results, 2,008-bed OhioHealth, which has eight member hospitals, including 422-bed Grant Medical Center, and nine ambulatory health centers has won the Spirit of Excellence community award.
Medical Director Richard Marger says wait times are less than those in a typical private office and communication with doctors back at the hospital is excellent. "All of (a patient's) medical, emotional and social needs are met right there," he says. "Our statistics rival that of a well-served population."
The program's operating budget is about $450,000, which does not include "millions of dollars" of free care over the years, says Sonia Booker, clinical coordinator. But fewer than 50 babies whose mothers have received the truck-based care have ended up in the neonatal ICU, which costs at least $3,000 per day per baby, she says. Funding has come through the OhioHealth Foundation, community groups and businesses.
The investment in prenatal care has been well worth it, says Ronald Ott, president of UPMC McKeesport (Pa.), who judged the community spirit category. "It really is so important in terms of how the family interacts with that, not only the mortality of the teens and the babies, but it sets them off on a path toward wellness for life."