Translating Policy to Practice and Back Again

The state of Delaware is in the unique position of implementing legislatively supported policy on preconception health. The state has allocated funding to translate preconception care policy to practice through a statewide program. The Delaware Division of Public Health has been given the responsibility of defining and implementing the preconception care program targeting a high-risk population. The state partnered with Medicaid, private practitioners, local hospitals, state service centers, and Federally Qualified Health Centers to develop a scope of program services that supplement the current clinical care provided at annual visits for women of childbearing age. Because the program has been in operation for 9 months, the Division of Public Health utilized feedback from the providing agencies to begin efforts for program sustainability and to modify the existing policy. Current efforts include developing outcome measures for the program, measuring program effectiveness through evaluation, and working with Medicaid and Managed Care Organizations to develop a reimbursement system for services.

Introduction

In response to an increasing infant mortality rate in Delaware when compared with the national rate (Delaware Vital Statistics Annual Report, 2007) the Governor of Delaware made reducing infant mortality a state priority. In 2005, she convened an Infant Mortality Task Force (IMTF) to assemble recommendations aimed at reversing the trend (Reducing Infant Mortality in Delaware, 2005). The IMTF provided the governor and state legislature with 20 recommendations to reduce infant mortality in Delaware. Several of the recommendations of the IMTF aimed to improve the health of women before pregnancy and called for increased access to preconception health care for Delawarean women, including providing increased access to preconception services for women with a history of poor birth outcomes; requiring that insurers cover services included in standards of care for preconception, prenatal, and interconception care; and improving comprehensive reproductive health services for all uninsured and underinsured Delawareans up to 650% of poverty. During 2005, the state legislature provided $1 million in funding to develop project and policy initiatives designed to impact infant mortality (Table 1).

In 2006, the core of the preconception care program was developed based on the Centers for Disease Control and Prevention (CDC) published recommendations for preconception health and health care in the United States (Johnson et al., 2006). The state legislature awarded >$0.5 million to develop a pilot program. The Delaware Division of Public Health (DPH) was tasked with developing the preconception program requirements, estimating program cost, and releasing a Request for Proposals to fund local agencies to implement the defined program and services.