Implementing an Enhanced Care Coordination Model for Pregnant Women With Syphilis

Primary and secondary syphilis among women in the United States increased 109% from 2012 to 2016. According to Center for Disease Control and Prevention (2018), congenital syphilis infections have increased each year since 2012 to 628 reported cases in 2016 (15.7 cases per 100,000 live births). In 2016, healthcare intervention averted 75% of potential congenital syphilis cases. Successfully intervening in potential congenital syphilis cases requires timely testing, diagnosis, and treatment of pregnant women with syphilis (Jin, 2018). In 2017, the Centers for Disease Control and Prevention (CDC) issued a Syphilis Call to Action, which along with other experts, recognized the need to improve prenatal care testing and timely and accurate syphilis treatment to prevent occurrence of congenital syphilis.

Using the health belief model as its conceptual framework, Enhanced Care Coordination Model (ECCM) was created, as a prevention program strategy, for pregnant females diagnosed with Syphilis (Age 15-44) within the jurisdiction of the local health department. This model was based on the most recent population health assessment of the locality and utilized best practices identified in care coordination among other local jurisdictions with high morbidity cases in the country. Logic model was utilized as the planning and evaluation framework of this study. Main aspects of the program are intended for the public health nurses of Maternal, Infant, Child, and Adolescent Health (MICAH) Bureau and HIV/STI Surveillance Bureau, which are both under the local health department. The ECCM is a care coordination model that aims to manage syphilis in pregnancy through synergistic efforts from both bureaus. Unique to the program is the utilization of the expertise of public health nurses in health education and care coordination, in partnership with disease interventions specialists.

The pilot program will run for three months and will be measured utilizing CDC-identified quantitative evaluation measures. Qualitative evaluation will be measured using focus group discussion of the participants of the study. The enhanced care coordination model (ECCM) can be used as a template in the implementation of a congenital syphilis case management process in other local jurisdictions most especially in high morbidity areas. The model also expands the potential roles of public health nurses in the field of sexual health.