Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Meeting ReportCommunity based participatory research

A Failure, Modes, and Effects Analysis (FMEA) exposes failures in prenatal home visitation referral for pregnant persons

Vaishali Patil, Catherine Kothari, Ruth Butters and Nia Evans
The Annals of Family Medicine November 2023, 21 (Supplement 3) 4998; DOI: https://doi.org/10.1370/afm.22.s1.4998
Vaishali Patil
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Catherine Kothari
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ruth Butters
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nia Evans
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Abstract

Context: In Kalamazoo County, infants of color are dying at 4X the rate of White infants; only 53% of eligible birthing people get home visitation (HV) referrals and a mere 13% are enrolled. The medical settings provide the lowest enrollment rate despite producing most HV referrals.

Objective: We used FMEA (a Six Sigma tool) to map the HV prenatal referral processes to identify gaps in care coordination with an aim to improve equity within HV programs and decrease disproportionate infant deaths.

Study Design: We conducted one-on-one interviews with CHWs and clinical providers serving pregnant persons. From these interviews, we created workflows and mapped the most commonly occurring failures. Risk priority numbers (RPN) for each of the identified failures were calculated via the product of their severity, frequency, and detectability. Failures were categorized as critical, high, medium, or low based on RPN.

Setting: Obstetrics clinics and home visitation programs serving pregnant persons and Medicaid patients in Kalamazoo, MI.

Population studied: Providers at 4 obstetrics clinics and CHWs at the 7 HV programs in Kalamazoo, MI.

Intervention: The semi-structured interviews with HV programs (referral-responding) and obstetric clinics (referral-generating) serving pregnant Medicaid patients helped to understand the processes involved in the referral of patients from point of entry into the clinic to receiving the services.

Outcome measures: The steps and fail points in the referral processes.

Results: Multiple fail points were identified in both the processes. High-impact failures on the clinic-side included understaffing on the medical side (RPN 482) and CHWs (RPN 462), navigation burden falling on stressed patients (RPN 464), and lack of follow-up (RPN 427). On the HV-side, failures included inaccurate and missing contact information (RPN 559), insufficient administrative capacity to track referrals (RPN 518), and lack of HV-integration into care pathway (RPN 450).

Conclusion: The iterative quality improvement process will continue with developing and implementing plans to address the critical failures within both systems. This will be followed by generation of another set of RPN. Comparison of pre-, post-RPNs will aid in quantifying the change in the system post implementation thereby ensuring a continuous qualitative improvement of the processes and the system. This will help address care quality gaps and create an equitable health system.

  • © 2023 Annals of Family Medicine, Inc.
Previous
Back to top

In this issue

The Annals of Family Medicine: 21 (Supplement 3)
The Annals of Family Medicine: 21 (Supplement 3)
Vol. 21, Issue Supplement 3
1 Nov 2023
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Failure, Modes, and Effects Analysis (FMEA) exposes failures in prenatal home visitation referral for pregnant persons
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
A Failure, Modes, and Effects Analysis (FMEA) exposes failures in prenatal home visitation referral for pregnant persons
Vaishali Patil, Catherine Kothari, Ruth Butters, Nia Evans
The Annals of Family Medicine Nov 2023, 21 (Supplement 3) 4998; DOI: 10.1370/afm.22.s1.4998

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
A Failure, Modes, and Effects Analysis (FMEA) exposes failures in prenatal home visitation referral for pregnant persons
Vaishali Patil, Catherine Kothari, Ruth Butters, Nia Evans
The Annals of Family Medicine Nov 2023, 21 (Supplement 3) 4998; DOI: 10.1370/afm.22.s1.4998
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Co-occurring Issues Facing Patients Who Use Unregulated Drugs: Insights From a Survey in Edmonton, Canada
  • Translating the Medicare Annual Wellness Visit into Messages and Materials to Improve Preventive Care In Older Adults.
  • Dissemination pilot of a culturally-tailored HPV educational website for Hmong adolescents and parents in clinics and schools
Show more Community based participatory research

Similar Articles

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine