Simple test could offer key to improving high infant mortality rateTweet
By Laura Sausser
The Post and Courier
Do you smoke? Do you drink? Are you safe at home?
They’re simple questions, but critically important for pregnant women to consider.
Smoking cigarettes and drinking alcohol can stunt a baby’s growth in the womb or cause premature birth, lifelong defects or death. Domestic violence and emotional instability are reliable red flags of an unhealthy home environment. All this is well documented.
But why more obstetricians and gynecologists in South Carolina aren’t screening their pregnant patients for these risky behaviors is proving a tougher nut to crack. The crux of the problem is improving South Carolina’s infant mortality rate. Babies are dying before their first birthdays at higher rates here than in most other states. One agency head said it “might be the state’s most profound health problem.”
In 2011, the S.C. Department of Health and Human Services developed a screening tool for doctors to ask pregnant Medicaid patients about their tobacco use, alcohol and substance abuse, domestic violence and mental health. They call the test “SBIRT,” short for screening, brief intervention and referral to treatment.
It takes a few minutes to administer — it’s eight questions and one page long — and doctors get paid to do it. Medicaid reimburses the doctor’s office at least $24 for each completed SBIRT test. But doctors aren’t using it.
Allison Lukacic, manager of the HHS Health Initiatives Team, said the agency has paid doctors for more than 4,000 of these tests since April 2012, but about 3,000 Medicaid patients give birth every month, which suggests the vast majority of — at least eight out of 10 — expectant moms with Medicaid cards are not screened using SBIRT, she said.
“Our initial goal is to have 100 percent of our pregnant Medicaid beneficiaries screened,” Lukacic said. “We’re not there yet, but we’re working very hard to get there.”
The end goal of the SBIRT test is to get women the help they need to keep their babies healthy.
Those numbers aren’t encouraging either.
Since the SBIRT test was implemented, Lukacic said data show the test has prompted as many as nine women and as few as zero to seek treatment during any given month.
“The numbers are very, very low,” she said. “We are significantly behind.”
Bob Toomey, director of the S.C. Department of Alcohol and Other Drug Abuse Services, said the first step is making the test mandatory for all pregnant women in the state.
“I hope it’s something that becomes standard practice,” Toomey said.
Jill Mauldin, M.D., medical director of women’s care at MUSC, admits her practice doesn’t have a perfect record of administering the test.
That’s why MUSC doubled down its efforts in January to make sure all pregnant women, whether they’re Medicaid patients or not, are asked the SBIRT questions by a medical assistant during their first visit.
“We try to use it to increase our compliance and our comfort with it and to get into the habit of it,” she said.
The test is designed to help doctors offer treatment options to their patients through a variety of state-sponsored programs, but Mauldin is skeptical it will work because many patients lie about these risky behaviors.
“That’s made it kind of frustrating,” she said.
HHS Director Tony Keck has tasked his department with figuring out how to increase voluntary participation among providers.
“Considering that the U.S. is falling further and further behind with birth outcomes and that South Carolina is at the bottom of the U.S., that problem is a problem we’ve got to get solved,” Keck said. “We’ve got worse birth outcomes than some developing countries.”
Save the Children Federation issued a national report this month showing an average 3.2 babies out of every 1,000 born in South Carolina die within 24 hours of birth, significantly higher than the national rate of 2.6.
In Charleston County, the report revealed that 3.8 babies of 1,000 born die on their first day.
“The outcomes we have are really unacceptable, and we can do better,” said Scott Sullivan, M.D., an MUSC physician and a member of the South Carolina Birth Outcomes Initiative, a group brainstorming ways to improve infant mortality rates, among other problems.
The bottom line is the SBIRT test is proven to work when it’s administered consistently, he said.
“I just did one like three minutes ago,” Sullivan said in an interview last week. “It’s cheap. It’s quick. It works.”
Editor’s note: The article ran in the May 21 issue of The Post and Courier and is reprinted with permission.May 29, 2013