Taxonomy I Part IV-B (Women's Health – Obstetrics)

(19 March 2006 11:51)

NATIONAL PROJECT ON THE COMMUNITY BENEFITS

OF FAMILY MEDICINE RESIDENCY PROGRAMS

CUMULATIVE QUESTIONNAIRE RESPONSES

Taxonomy Section I Part IV-B

(Women’s Health – Obstetrics)

SD I.2b (CEH)) Does your residency program include obstetrical care as part of a women’s health program? Yes __ No __

Yes:

OHSU Portland

*NPCB P2.I.2g.1 (CEH) If you have an element of your residency program that you define as a “women’s health center”, does your residency program include obstetrical care as part of that women’s health center? Yes __ No __

Yes:

Ventura

McKeesport

Johnstown                    (in both family medicine center and women’s health center)

Lebanon

Latrobe

No:

Altoona

No Response Recorded:

Huntsville

*NPCB P2 I.2b (SD I.2c (CEH)) Do your OB patients come from your practice (i.e. are continuity patients of your family medicine center), or are they from an outside agency?

From practice:  Yes __ No __

Yes:

OHSU Portland

Sparrow

Huntsville

Ventura

Long Beach

Crozer-Keystone

Jefferson

McKeesport

Oahu

Shadyside

Johnstown

Altoona

St Margaret

Fairfax

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

No Response Recorded:

U Penn

From outside agency: Yes __ No __

Yes:

OHSU Portland

Sparrow

Huntsville

Ventura

Long Beach

Jefferson

Oahu

Shadyside

Altoona

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

No:

Crozer-Keystone

McKeesport

Johnstown

St Margaret

Fairfax

No Response Recorded:

U Penn

*NPCB P2 I.2d (SD I.2d) (CEH) Are residents in your program required to follow continuity OB patients? Yes __ No __

Yes:

OHSU Portland

Sparrow

Hunstville

Ventura

Long Beach

U Penn

Crozer-Keystone

Jefferson

McKeesport

Oahu

Shadyside

Johnstown

Altoona

St Margaret

Fairfax

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

*NPCB P2 I.2e (SD I.2e (CEH)) Is there an “OB track” in your program?

Yes __ No __

Yes:

Sparrow                       (not really formalized, but we have senior rotations designed for those who plan to do OB)

Crozer-Keystone

Altoona

St Margaret

Reading

Monroeville

No:

OHSU Portland

Huntsville                      (but there is an OB fellowship)

Ventura                        (everyone is expected to do OB)

Long Beach

U Penn

Jefferson

McKeesport

Oahu

Shadyside                     (but we are moving towards having one)

Johnstown

Fairfax

Santa Rosa

York

Lebanon

Billings

Beaver

Latrobe

*NPCB P2 I.2e(1) If the answer to NPCB P2 I.2(e) is yes, does the track lead to specialized privileges? Yes __ No __

Yes:

Crozer-Keystone       (non-complicated OB privileges)

Altoona                     (for a recommendation for the graduate to do OB, we have requirements for residents that exceed the RRC requirements for continuity deliveries)

No:

Sparrow

St Margaret

Reading

Monroeville

*NPCB P2 I.2f (SD I.2f (CEH)) Can residents in your program become credentialed to do C-sections? Yes __ No __

Yes:

OHSU Portland

Huntsville                      (theoretically)

Ventura

Shadyside                     (yes, if they do an obstetrical fellowship following their residency)

Reading

Beaver                         (if they do enough C-sections, they could be; however, it has been some time since anyone chose this option)

Latrobe

No:

Sparrow                       (occasionally, someone with extra experience does this)

Long Beach

U Penn

Crozer-Keystone

Jefferson

McKeesport

Oahu

Johnstown

Altoona

St Margaret

Fairfax

Santa Rosa

York

Lebanon

Billings

Monroeville                  (not here; grads have to becoming credentialed after residency)

*NPCB P2 I.2f(1) (PAC) If the answer to NPCB P2 I.2f is yes, can such residents be credentialed to do C-sections within your institution?

Yes:

Huntsville                      (after they do an obstetrical fellowship)

Ventura

Shadyside                     (we can perform C-sections in the hospital, if trained to do so)

Beaver

No:

Reading                        (probably not)

Latrobe                        (not currently)

SD I.13f(2) Does your residency program provide the following kinds of specialty care? f(2) Pre-natal care? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

No:

Tyler                            (we diagnose pregnancy; once they are determined to be pregnant, they go to a different hospital, but are seen by residents there)

SD I.13f(2.1) If you do provide pre-natal care, are those services provided as normal family medicine center appointments?

Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

SD I.13f(2.2) If you do provide pre-natal care, are those services provided during special clinics?  Yes __ No __

Yes:

Las Vegas                    (a clinic will start in April, 2005 for low-risk obstetrical patients)

Springfield                    (sonogram clinic)

Glasgow

No:

Fresno

Lexington

OHSU Portland

If the answer to SD I.13f(2.2) is yes, what is the number of patients seen?  What revenues are generated in each specialty service?

Las Vegas                    (unknown number of patients; revenues of $50,000 expected)

Springfield                    ($30 per sonogram from public aid; up to $160 per sonogram for insured)

Glasgow                       (6-10 per clinic; OB has a global charge of $1000-$1500 per delivery)

Describe the kinds of pre-natal care that typically takes place within the family medicine center (whether as normal appointments or during special clinics:

Las Vegas                    (all types – teens to older moms; complicated pregnancies)

Fresno                          (normal pre-natal care)

Springfield                    (low risk OB; initially manage hypertension, gestational diabetes, URIs and UTIs during pregnancy)

Glasgow                       (general check-ups, initial exams, and lab testing, all billed to the hospital)

Lexington                     (-)

OHSU Portland            (-)

*NPCB P2 I.2h.1 Does the residency program perform pre-natal care within the family medicine center? Yes __ No __

Yes:

Sparrow

Huntsville

Ventura

Long Beach

U Penn

Crozer-Keystone

Jefferson

McKeesport

Oahu

Shadyside

Johnstown

Altoona

St Margaret

Fairfax

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

No:

Latrobe                        (done at women’s health center)

*NPCB P2 I.2h.4 Describe the kinds of pre-natal care that typically takes place within the family medicine center (whether as normal appointments or during special clinics):

Sparrow                       (normal appointments)

Huntsville                      (normal appointments; regular pre-natal care)

Ventura                        (average risk and high risk patients, the latter in consultation with OB staff; normal appointments)

Long Beach                  (normal appointments scheduled with a primary doctor and social worker)

U Penn                         (normal appointments)

Crozer-Keystone          (low to moderate risk)

Jefferson                       (normal appointments)

McKeesport                 (regular appointments; healthy beginnings; counseling; breastfeeding information; adoption agency health exams; special programs; continuity of care provided by one resident; high risk care in FMC with obstetrical consultation; adoptions before delivery)

Oahu                            (routine, normal prenatal care appointments)

Shadyside                     (we have see both normal and medium risk pregnancies; we have special clinics for twins, patients with hypertension, gestational diabetes requiring insulin where our patients are co-managed with obstetricians)

Johnstown                    (we have intake time with designated continuity residents; monthly visits take place in family medicine center; we follow guidelines and protocols set by the women’s health center)

Altoona                        (our normal appointments include the usual pre-natal care exams and patient education)

St Margaret                  (we provide pre-natal care in both normal appointments and special clinics)

Fairfax                          (the full spectrum of pre-natal care, including some high risk)

Santa Rosa                   (we do high risk, low risk, late to care – in a specialty clinic within the family medicine center, we takes referrals from the public health department that we see in a specialty clinic)

Reading                        (we do normal pre-natal care within both normal appointments and designated special prenatal clinics)

York                            (low risk pre-natal care and concurrent care with OB specialists of intermediate and high risk patients)

Lebanon                       (we do low risk care during standard appointments)

Billings                          (routine intake and follow-up visits; we do non-stress tests and ultrasound)

Monroeville                  (comprehensive prenatal care, including twins with OB backup)

Beaver                         (we do low and high risk OB, both in normal appointments and in specialty clinics held Tuesday and Friday)

Latrobe                        (we do not pre-natal care in the family medicine center; in the women’s health center, we provide care to both low and high risk patients)

*NPCB P2 2h.4.1 What kinds of pre-natal care would your residency program routinely refer out of your family medicine center:

Sparrow                       (our system has a community service clinic; we will refer out a pregnant woman with diabetes or with heart disease; abnormal growth; pre-eclampsia)

Huntsville                      (high risk, such as diabetic patients; occasionally, sickle cell patients)

Ventura                        (very high risk patients, including twins with complications, and active pre-term labor; the continuity resident keeps the patients, but co-manages them with obstetricians)

Long Beach                  (only high risk, following established guidelines on weeks, etc; no multiple gestations)

U Penn                         (high risk)

Crozer-Keystone          (high risk)

Jefferson                       (high risk)

McKeesport                 (genetic issues for genetic counseling; abortions; adoptions after birth)

Oahu                            (multiple gestations; cervical incompetence; second trimester building; insulin-requiring diabetes management; hypertensive, renal disease; structural cardiac problems; lupus; other high-risk pregnancies)

Shadyside                     (extremely high risk: advanced renal disease, sickle cell anemia, thrombophiliacs, severe eclampsia)

Johnstown                    (high risk OB, multiple gestations, previous Caesarians; people with insurance that requires that only obstetricians provide care)

Altoona                        (high risk such as twins; repeat elective CSX not wanting BVAC; a request for a referral from the patient)

St Margaret                  (high risk patients; IUGR; complex diabetes; placentia previa)

Fairfax                          (twins and multiple births; complicated medical problems such as insulin-dependent diabetes; pre-term labor)

Santa Rosa                   (almost nothing; extraordinarily high risk is done here, with help; there is no certified perinatologist in Sonoma County)

Reading                        (high risk)

York                            (severe IUGR; recurrent miscarriages; incompetent cervix; complicated diseases such as diabetes or hypertension; connective tissue diseases like lupus)

Lebanon                       (pre-term labor; genetic anomalies; twin, etc)

Billings                          (multiple gestations; uncontrolled diabetics; we co-manage everyone else, including most high risk)

Monroeville                  (we refer out known congenital anomalies, and some high risk that is referred to a high risk perinatologist at an affiliated hospital)

Beaver                         (nothing)

Latrobe                        (all of it, because we refer it to our women’s health center, except, if there is a medical problem, they are managed in the family medicine center; in Western Pennsylvania all OB care is done by OB/GYN, except in FMRPs)

Previous Ultrasound Questions

SD I.2 h(0.1) (SD I.13g(1.0) (SD I.13s (1) (L32))) Does your residency program provide the following kinds of specialty care?   g(1.0). Level 3 Ultrasound for Obstetrics? Yes __ No __

Additional Info:  If yes, are these services provided during special clinics? What is the number of patients seen? What are the revenues that are generated?

Yes:

OSU Tulsa

No:

USC Univ & SG

Modesto

Saints

Indiana U Methodist

SD I.2h(0.2) ((SD I.13g(1.0.1) (SD I.13s(2) (L32)) Does your residency program provide the following kinds of specialty care?  Level 3 Ultrasound for Obstetrics?  Yes__ No __

Yes:

Pomona

No:

Whittier

SD I.2h(0.3) ((SD I.13g(1.02) (SD I.13s(3)) If you do provide Level 3 Ultrasound for Obstetrics, are these services provided as normal family health center appointments? Yes __ No __

No:

Pomona

SD I.2h(0.4) ((SD I.13g(1.0.3) (SD I.13s (4)) If you do provide Level 3 Ultrasound for Obstetrics, are these services provided during special clinics? If so, what is the number of patients seen?  What revenues are generated in each specialty service?

Yes:

Pomona

SD I.2h(1) ((SD I.13g(1.1) (SD I.13u(2) (L32)) Does your residency program provide the following kinds of specialty care?  Ultrasound for Obstetrics?  Yes__ No __   (If yes, identify level)

Yes:

Arrowhead                   (Basic and Level 2)

Loma Linda                  (Basic)

Stockton                      (Basic)

Glendale                       (Basic and Level 2)

OU Tulsa                     (Basic)

OU Oklahoma City      (Level 1)

Natividad

Klamath Falls               (Levels 1 through 3)

Kaiser LA                    (Basic)

Fresno                          (Basic level; takes place at Selma)

Springfield                    (Level 1)

No:

Louisville

MCE Birmingham

Dayton Community

Miami Valley

Decatur

Mercer

Lehigh Valley                (Basic; takes place in Health Spring practice)

Mercy Toledo

Tyler

Las Vegas

Glasgow

Lexington

SD I.13g(I.2) (SD I.13u(3)) If you do provide Ultrasound for Obstetrics, are these services provided as normal family health center appointments? Yes __ No __

Yes:

Loma Linda

Stockton

OU Tulsa

OU Oklahoma City

Natividad                     (The equipment is in the obstetrical testing area of the hospital, but the equipment is used by family medicine residents in their routine patient care)

Klamath Falls

Springfield

No:

Arrowhead

Glendale

Kaiser LA                    (not often)

Fresno

SD I.13g(1.3) (SD I.13u(4)) If you do provide Ultrasound for Obstetrics, are these services provided during special clinics?

Yes __ No __

If yes, what is the number of patients seen?  What revenues are generated in each specialty service?

Yes:

Arrowhead                   (200/yr)

Loma Linda                  (60/yr)

Stockton                      (3/clinic)

Glendale                       (1/week)

OU Tulsa                     (8 patients per weekly half-day clinic; just dating, no anomaly scans; the latter take place during a high risk obstetrics clinic for high risk GYN procedures, which is held once a week, 6 are seen per clinic; estimated 300 patients a year)

OU Oklahoma City      (revenues of an unknown amount are generated)

Natividad

Klamath Falls               (40/month; $4500 month)

Kaiser LA                    (12/wk)

Fresno                          (2/wk at Selma; revenues are received indirectly)

Springfield                    ($30 per sonogram from public aid; up to $160 per sonogram for insured)

SD I.h(2) Do you incorporate ultrasound training for the residents? Yes __ No __

Yes:

OHSU Portland

*NPCB P2 I.2j (CEH) Does your residency program incorporate ultrasound training for the residents? Yes __ No __

Yes:

Huntsville

Ventura

U Penn

Jefferson

McKeesport                 (at Mercy Hospital; some at FMC)

Shadyside                     (basic; no certification is provided)

Johnstown                    (basic)

Altoona                        (level 1)

Santa Rosa                   (level 1)

Billings              (basic, with option to learn anatomic surveys)

Monroeville                  (up through level 2)

Beaver                         (basic)

Latrobe                        (basic)

No:

Sparrow

Long Beach

Crozer-Keystone

Oahu

St Margaret

Fairfax                          (there is some cursory use of ultrasound, such as identifying location of placenta and baby’s head)

Reading

York

Lebanon

SD I.2g(2.06) (CEH) Indicate which of the following procedures are performed in your family medicine center or women’s health clinic:

(2.06) OB Ultrasound? Yes __ No __ If yes, at what level(s)?

Yes:

OHSU Portland            (Level 1)

*NPCB P2 I.2g(2.05.1) (SD I.2g(2.05) (CEH)) Indicate which of the following procedures are performed by your residency program.  If a procedure is performed by the residency program, but not within the family medicine center, please explain in which setting that procedure takes place.

(2.06.1) OB Ultrasound? Yes __ No __ If yes, at what level(s)?

Yes:

Huntsville                      (fetal survey; dating; first trimester)

Ventura                        (basic)

Long Beach                  (dating; no anatomy)

U Penn                         (Level 1)

Jefferson                       (Levels 1 and 2; at Labor and Delivery Suite)

McKeesport                 (Basic in FMC; higher levels at UPMC McKeesport MC)

No:

Sparrow                       (we refer to the Radiology Department)

Crozer-Keystone

Oahu

Last Updated (19 August 2006 20:12)