Addressing the Social Determinants of Health for Pregnant, Housing-insecure Women through an Integrated Care Model

Angela Zhang, BA, BS
Department of Medicine
Division of Women’s Health
Poster Overview

Housing insecurity is a persistent and worsening issue in Boston that intersects with social issues including poverty, hunger, and violence. For homeless, expectant mothers who face many of these challenges simultaneously, there are enormous barriers to securing the care that they need during pregnancy. Bridges to Moms is a collaborative program between Brigham and Women’s Hospital (BWH) and the nonprofit Healthcare Without Walls that meets these women in the field to address the needs that are often not met within the walls of a hospital, including transportation access, food security, housing advocacy, and personal safety. To measure the impact of the Program on maternal and newborn health, a group of women at BWH who were similarly housing-insecure and pregnant but were not enrolled in the Program were studied for comparison. We found that mothers in the Program attended more appointments and were more likely to find stable housing, connect to primary care, and use birth control. Additionally, their babies spent fewer days in the neonatal intensive care unit. Bridges to Moms provides compelling evidence for an integrated model of care that complements existing healthcare services with personalized, community-level care that addresses the social determinants of health of housing-insecure, pregnant women.

Scientific Abstract

Housing-insecure, pregnant women face enormous, unique barriers to healthcare that necessitate intervention beyond the standard of care confined within hospital walls. Through the Bridges to Moms Program, a community-based field team addressed four social determinants of health: transportation, food security, housing, and personal safety for 134 pregnant, housing- insecure women who received prenatal care and delivered at Brigham and Women’s Hospital (BWH). Compared to a control group of 133 housing-insecure, pregnant women at BWH not enrolled in the Program, the intervention group had statistically significant higher prenatal and post-partum clinic attendance rates, more stable housing placements, greater connections to continuity care, more consistent birth control, and shorter stays in the neonatal intensive care unit. We demonstrate that in tandem with the traditional obstetrical services offered during pregnancy, a program that provides community-based, personalized case management, medical referral, and social support for this vulnerable population improves maternal and newborn health during pregnancy and the postpartum period. We propose that such an integrated care model that addresses both biological and social determinants of health has the potential to be replicated across hospital systems to bridge the gaps in healthcare experienced by housing-insecure expectant mothers and their infants.

Clinical Implications
Addressing the social determinants of health of housing-insecure, pregnant women through a personalized, community-based program resulted in higher clinic attendance rates, more stable housing placements, greater connections to continuity care, more consistent birth control, and shorter stays in the NICU.
Research Areas
Authors
Angela L.R. Zhang; Roseanna H. Means, MD; Jo-Anna Rorie, CNM, MSN, MPH, PhD; Amy Coe, NP
Principal Investigator
Roseanna H. Means, MD

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