Prenatal - First Trimester Care Access

Part 1: Introduction

Part 2: Characteristics for Success: Prenatal - First Trimester Care

Part 3: Implementation of Clinical Quality Measure: Prenatal - First Trimester Care Access

Part 4: Improvement Strategies: Prenatal - First Trimester Care Access

Part 5: Holding the Gains and Spreading Improvement

Part 6: Supporting Information

Part 6: Supporting Information 

To gain insight into how one QI team approached this measure, review a case study highlighting Happy Farms' Quality Assurance Program and its approach to improving Prenatal-First Trimester Care Access.

1. Centers for Disease Control and Prevention. 2006. Safe Motherhood: Promoting Health for Women Before, During and After Pregnancy, 2006.
2. Institute of Medicine. Preventing low birthweight. Washington, DC: National Academy Press, 1985.
3. U.S. Congress, Office of Technology Assessment. Healthy Children: investing in the future, Washington, DC: U.S. Government Printing Office, 1988;OTA-H-345.
4. Gortmaker SL. The effects of prenatal care upon the health of the newborn. Am J Public Health 1979;69:653-60.
5. Sokol RJ, Woolf RB, Rosen MG, Weingarden K. Risk, antepartum care, and outcome: impact of a maternity and infant care project. Obstet Gynecol 1980;56:150-56.
6. Quick JD, Greenlick MR, Roghmann KJ. Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. Am J Public Health 1981;71:381-90.
7. Peoples MD, Siegal E. Measuring the impact of programs for mothers and infants on prenatal care and low birth weight: the value of refined analyses. Medical Care 1983;21:586-608.
8. Greenberg RS. The impact of prenatal care in different social groups. Am J Obstet Gynecol 1983;145:797-801.
9. Showstack JA, Budetti PP, Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health 1984;74:1003-8.
10. Fisher ES, LoGerfo JP, Daling JR. Prenatal care and pregnancy outcomes during the recession: the Washington State Experience. Am J Public Health 1985;75:866-9.
11. Shiono PH, Klebanoff MA, Graubard BI, Berendes HW, Rhoads GG. Birth weight among women of different ethnic groups. JAMA 1986;255:48-52.
12. Moore TR, Origel W, Key TC, Resnik R. The perinatal and economic impact of prenatal care in a low socioeconomic population. Am J Obstet Gynecol 1986;154:29-33.
13. Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med 1987;317:743-8.
14. Koonin LM, Atrash HK, Lawson HW, Smith JC. Maternal mortality surveillance, United States, 1979-1986. In CDC Surveillance Summaries, MMWR 1991;40(SS-1):1-13.
15. Poland ML, Ager JW, Sokol RJ. Prenatal care: a path (not taken) to improved perinatal outcome. J Perinat Med 1991;19:427-33.
16. McLaughlin FJ, Altemeier WA, Christensen MJ, Sherrod KB, Dietrich MS, Stern DT. Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight. Pediatrics 1992;89:128-32.
17. United States Department of Health and Human Services, Preventing Infant Mortality Fact Sheet, January 2006, (July 21, 2008).
18. Mathews TJ, MacDorman MF. 2006. Infant mortality statistics from the 2003 period linked birth/infant death data set. Natl Vital Stat Rep 54(16):1-29.
19. March of Dimes (2009)
20. Adapted from HRSA Clinical Quality Performance Measures (2009)
21. Healthy People 2010 (n.d)
22. The State of Health Care Quality 2008 [PDF | 3.6MB]
23. Institute of Medicine. Breakthrough Series College Aim Statement Checklist. Boston: Institute for Healthcare Improvement. February 2004,
24. Adapted from pre-work manual used in HRSA sponsored Health Disparities Collaborative
25. NQC "A Guide to Consumer Involvement"
26. Timmermans S, Mauck A (2005). The promises and pitfalls of evidence-based medicine. Health Aff (Millwood) 24 (1): 18-28. doi:10.1377/hlthaff.24.1.18. PMID 15647212.
27. Adapted from Chronic Care Model...
28. Langley G., Nolan K., Nolan T., Norman C., Provost L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco. Jossey-Bass, 1996.

1. U.S. Department of Health and Human Services, Health Resources and Services Administration. Women's Health USA 2008. Rockville, Maryland
2. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, Fifth Edition; Elk Grove Village, IL, AAP/ACOG 2002.
3. Physician Performance Measures
4. Joint Commission
5. A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000) Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr.
6. National and State Maternal and Child Health (MCH)
7. NQF-Endorsed™ National Voluntary Consensus Standards for Physician-Focused Ambulatory Care. APPENDIX A -NCQA Measure Technical Specifications, April, 2008 V.7
8. AHRQ Innovations Exchange. - Strategies and quality-related tools to improve an organization's ability to innovate and adopt new ideas, and interact with innovators and adopters.
9. MCH Library Knowledge Path: Preconception and Pregnancy Online bibliography of information related to preconception and prenatal care.
10. Childbirth Connection. Founded in 1918, National not-for-profit organization concerned with improving the quality of maternity care.
11. DoD/VA clinical practice guideline for management of uncomplicated pregnancy. Department of Defense - Federal Government Agency [U.S.] Department of Veterans Affairs - Federal Government Agency [U.S.] Veterans Health Administration - Federal Government Agency [U.S.]. 2002 Oct. Various pages. NGC:003062
12. Routine prenatal care. Institute for Clinical Systems Improvement - Private Nonprofit Organization. 1997 Aug (revised 2008 Aug). 89 pages. NGC:006704
13. Health IT Adoption Toolbox