The JJ Way® – A Patient-Centered Model of Care
The JJ Way® Model is effective in reducing disparities and improving outcomes because it operates from the premise that every woman wants a healthy baby and that every woman deserves one. Additionally, patients and their family supporters (if any)are encouraged to operate the same way and are therefore invited in as an integral part of each prenatal visit. From the very first appointment the goal of a full-term healthy baby is emphasized and all subsequent measures stress that theme until safe arrival at that point.
Key Components, Objectives and Goals
The key objectives of The JJ Way® are:
- For pregnancies to reach a gestation of 37 weeks or greater.
- For newborns to have a birth weight of 5 lbs. 8 oz or greater.
- For women (and their families) to bond well to their babies.
- To start and succeed at breastfeeding.
The JJ Way’s innovative model builds on the strengths of the Midwives Model of Care to reach a population that does not typically seek midwifery services.
The goals of The JJ Way® are:
- To provide a model that is easy to duplicate which allows the healthcare provider to run an efficient, safe and productive system.
- To provide training and organizational systems for medical establishments that wish to improve their patient and employee satisfaction, compliance, and loyalty along with reducing litigation.
- On a corporate/ private level to engage organizations in the value of healthy women and thereby families and the importance of a new approach in providing that information.
- On a community level to engage and educate families, business owners, ‘leaders’ and churches in the urgency of the problem and how they can help to be part of the solution.
The key components in our health care delivery are: prenatal bonding through respect, support, education, encouragement and empowerment.
Freedom of Choice: Labor and delivery can take place in any location the woman feels most comfortable. We take the fear of un-medicated or out-of-hospital childbirth out of the equation. We work with our physician partners to ensure a smooth transition of care for women who prefer to birth at the hospital.
Self-Reliance: The mother participates as an equal partner, with knowledge presented at her level. We offer practical suggestions that support self- reliance. All along the way, we recognize and acknowledge the woman as completely capable of fulfilling the role of motherhood. Each client carries her own mini-health chart — our prenatal care passport card. Every visit, lab result, and appointment is logged, plus 24-hr contact and signs of premature labor. The client takes her passport card with her to any doctor visits and when she goes to the hospital in labor, helping to ensure continuity of care.
Easy Access: From the moment a pregnant woman enters the clinic, a team member greets her warmly. This immediate connection is a simple but critical part of the accessibility of the practice. No one is turned away, and this reputation in the community makes it easier for women to take the first step of entering the clinic. Once there, she has access to the entire staff team for questions, support and medical care. She will leave having had a prenatal exam and having established a maternity medical home. Read more about our Easy Access Prenatal Clinic
Team Approach: Each staff member has a role to play, from the receptionist who greets each woman by name when she walks through the door, to the office manager who knows every client. Family members, the father of the baby, and friends are also brought in as part of the mother’s team. Together all members are engaged in the explicit goal of helping the mother achieve a healthy, full-term pregnancy. Weekly staff meetings include every employee, and the team discusses each client. At staff meetings, everyone is kept informed about each client’s situation and is engaged in the case management process and plan. We then work to deliver consistent health messages and expectations. A client often develops a bond with a particular staff member. We capitalize on that special connection by allowing that team member to play a larger role in delivering information and providing support, even if she is not in a medical role. Each team member always has the support and insight of the entire team.
Connection Creation: We work hard to promote prenatal bonding not only between mother and baby, but also with the father, siblings, extended family, friends, and clinic team members; our team approach builds the social capital of each woman, ensuring success beyond her pregnancy and delivery.
Gap Management: The team works together to identify any gaps or barriers the client is facing and begins ‘gap management’ triage. We then work to provide practical solutions based on the real life situation of each woman and engage all pertinent team players and outside resources in the process.
Education: We inspire knowledge through alternative approaches to teaching, with peer educators, and by making waiting room time learning time, often in groups with an informal, friendly feel, yet still thorough. Through our ‘gap management’ and team approach, we tailor educational messages and delivery approaches to the clients. Also, we focus on post-partum education, including providing breastfeeding support and family planning information. Knowing that short inter-pregnancy intervals are associated with low birth-weight and prematurity, we teach women the importance of letting their bodies rest between pregnancies and help them establish a plan for birth control.
Outcomes and Results
Outcomes have improved over the past five years and we are currently conducting a one year research study on the impact of The JJ Way® on improved perinatal health. Prenatal bonding has allowed us to engage not only the pregnant women but their partners, families and supporters as well. It has led to:
- Increased vigilance for risk factors.
- Increased compliance with instructions and appointments.
- Reduced fear of poor outcome and impending harm to mom or baby.
- Increased sense of empowerment and control.
For a minimum ‘up-front’ cost, countless heath care, remedial school care and ultimately criminal justice Dollars have been saved. The ultimate bonus however is the strong, vital connection of a fully bonded mother and baby, a connection which will carry forward into the future of the family, the community and society at large.
In the USA, despite ongoing research and discussion, perinatal health disparities are not improving in any great fashion, and in some areas the gap is actually widening. Newer interventions are focusing on more holistic approaches including looking at stress, environment and life-course approaches. The JJ Way® is a simple, cost-effective model which can be easily emulated and adapted for any practice, and which has the potential to seriously impact the discouraging perinatal statistics that have become all too common.
Evaluation of The JJ Way®
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