In November 2006, the Winter Park Health Foundation awarded Commonsense Childbirth, Inc. funding to cover prenatal care expenses for 100 pregnant women who were uninsured and under insured clients of The Birth Place. Additionally, the Foundation provided funding to the Health Council of East Central Florida, Inc. to design and conduct the program evaluation. The grant was provided to research the effects of The JJ Way model on birth outcomes. The evaluation study began in December 2006 and concluded on December 31, 2007. Clients were enrolled in the study from December 2006 through the summer of 2007 and followed through their pregnancies and deliveries and then contacted a few months after giving birth. Each client signed a consent to participate in the study. Quantitative data collected included numbers of low birth weight babies born to enrolled clients, defined as less than 5 lbs 8 oz, and numbers of preterm babies, defined as gestation of less than 36 completed weeks. The Health Council also collected qualitative data by tracking payor source of enrolled clients, and developing and conducting a telephone survey for follow up with the clients after delivery.
A total of 100 women were enrolled in the study. The delivery status of the clients can be found in the table below.
|Status||Number of Clients|
|Delivered Live Birth||84|
|Moved 1st Quarter||3|
|Moved 2nd Quarter||2|
|Moved 3rd Quarter||3|
|Transferred to High Risk OB Practice at Winnie Palmer||2|
|Transferred to an obstetrics practice||2|
Of the 84 who remained with the program throughout their care and delivered a live birth, 45.9% self-identified as White, 29.4% were African American and 16.5% were Hispanic. The remaining 8.3% were identified as Asian, Haitian and West Indian.
The payor source of the enrolled clients was tracked during the study period. Payor source was tracked at first visit, if obtained during the study period, and if dropped during the study period. Only 4.7% of clients had private health insurance at their first visit, but were identified as “underinsured” for their prenatal care needs. A total of 48.2% of clients had Medicaid and 42.4% of clients had no insurance at all. The remaining 4.7% were funded through the Orange County Healthy Start Coalition, which covers undocumented residents. Of those women who had Medicaid at their first visit, 29.3% were dropped from Medicaid during the study period. Of those women who did not have Medicaid at first visit, 97.2% received Medicaid coverage at some point during the study. A total of 89.4% of all clients who delivered a baby had Medicaid coverage at some point during the study period. Of those clients, 63.5% had more than 10 Medicaid visits, which is the payment limit for Florida Medicaid.
Gestational Age and Birth Weight
The targeted outcome gestation age for the clients enrolled in the study was set at 37 weeks or greater. Babies born prior to 37 weeks are considered pre-term. A total of 95.3% of clients carried their babies for at least 37 weeks. In all, 4 babies (4.7%) were born before the 37-week gestation target. This is well below the pre-term percentage for babies born in Orange County and the State, 15.5% and 14.2%, respectively. Among African-American clients enrolled in the study, the percentage of pre-term births was zero. The average gestation for clients with a status of “delivered” was 38.9 weeks. It should be noted that one of the four pre-term babies was delivered at 23 weeks and was stillborn. The client had been compliant and no determination was made as the cause of the fetus’ demise. The targeted outcome birthweight for all births was set at 5lbs. 8oz. or greater for this study. A baby born below this weight is considered to be of a low birthweight. Over 95% of all births in this study were of normal weight. The average birthweight for the group was 7lbs. 7ounces.
Follow up survey results
As part of the evaluation of “The JJ Way” model, study participants were asked to complete a follow-up survey regarding their birthing experience. A $10 incentive was offered to each participant for completion of the survey instrument. The Health Council staff used the telephone numbers in the patient records to contact the mothers, including the emergency contact numbers. In many cases, the phone numbers were no longer in service. A request for participation in the survey was mailed to the addresses of record if the mothers were not reached by telephone. After two months of exhaustive effort tracking the patients, the Health Council was able to reach 42 participants and their results are analyzed below.
Participants were asked to rate the care that they received at the Birth Place on a scale of 1-5, with 5 being the highest. The highest satisfaction rating was given by 93% of the women surveyed.
- 98% of the women said they would recommend The Birth Place to others.
- 63% of the women are currently using a form of birth control.
- 100% of the women reported that their babies were healthy.
- 100% of the women reported that their baby sees a doctor regularly (i.e., for healthy visits, immunizations).
- 69% of the women responded that they have or are currently breastfeeding their baby.
Internal Evaluation of the JJ Way®: 2007-2008
Since the study, Commonsense Childbirth has continued to use the same process for data collection established by The Health Council of East Central Florida. For the two-year period of 2007-2008, Commonsense Childbirth collected data on 277 low-income clients. We also looked at c-section rates, and found that The JJ Way® clients had a 25% c-section rate during this two year period, compared to a 37% rate for Orange County in 2007. Altogether, The JJ Way clients were 32% less likely to have a c-section, 46% less likely to have a low birth weight baby and a 42% less likely to have a preterm baby than the average woman who birthed in Orange County in 2007. These differences represent a significant cost savings for the public, making The JJ Way® an effective way to cut costs in our health care system while improving outcomes.
Research Studies and Reports
Pertinent research studies and reports
- The JJ Way® Community based Maternity Center Evaluation Report 2017
- JJ-way AMCHP Best Practice
- Birth Place powerpoint Dr. Erica Gibson
- Jennie Joseph Excerpt 9-22-08 Dr. Erica Gibson (1)
- Jennie Joseph write-up DR. Erica Gibson 2013
Impact of Racism on Birth Outcomes
Dr. Michael Lu speaks about the impact of racism on birth outcomes