Program Email
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Today M-D-Y
Presenter's First Name
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Presenter's Last Name
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Presenter's Email
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Clinical Role
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Clinical Site
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Primary Insurance
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Medicaid Medicare Commercial Health Plan Self-Pay
Name of Medicaid
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Presbyterian Centennial Care BCBS Centennial Care Western Sky Community Care Centennial Other
If Medicaid plan is NOT in New Mexico please select 'Other'
Secondary Insurance
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Medicaid Medicare Commercial Health Plan Self-Pay None
Indicate "none" if no secondary insurance
Name of Medicaid
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Presbyterian Centennial Care BCBS Centennial Care Western Sky Community Care Centennial Other
If Medicaid plan is NOT in New Mexico please select 'Other'
What type of case would you like to present?
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OB Hemorrhage Case Form
Hypertension Case Form
General Case Form
Substance Use Disorder
OB HEMORRHAGE CASE PRESENTATION QUESTION(S) FOR NETWORK What are your specific question(s) about this case?
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Area(s) of bundle addressed in this case:
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Check all that apply.
If other, please explain.
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Patient Age
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Gestational Age (in weeks)
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Delivery Type
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Vaginal
Cesarean
Anesthesia
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Yes
No
Anesthesia Type
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Check all that apply.
What was the primary cause of the OB hemorrhage?
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Check all that apply.
If other, please explain.
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PPH Therapy
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Check all that apply.
If other, please explain.
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Was QBL used in this case?
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Yes
No
Please explain some of your barriers with using QBL.
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Blood Transfusion?
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Yes
No
Type of Blood Products
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Check all that apply.
Number of Units - Red Blood Cells:
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Number of Units - Platelets:
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Number of Units - FFP:
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Number of Units - Cryo:
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Brief Clinical Narrative
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What worked well?
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What barriers, obstacles or challenges did you encounter?
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HYPERTENSION CASE PRESENTATION QUESTION(S) FOR NETWORK What are your specific question(s) about this case?
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Area(s) of bundle addressed in this case:
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Check all that apply.
If other, please explain.
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Patient Age
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Gestational Age (in weeks)
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Delivered
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Yes
No
Delivery Type
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Vaginal
Cesarean
Anesthesia
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Yes
No
Anesthesia Type
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Check all that apply.
What was the primary diagnosis?
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Check all that apply.
If other, please explain.
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Hypertension Therapy
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Check all that apply.
If other, please specify.
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Brief Clinical Narrative
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What worked well?
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What barriers, obstacles or challenges did you encounter?
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GENERAL CASE FORM QUESTION(S) FOR NETWORK What are your specific question(s) about this case?
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Brief Clinical Narrative
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What worked well?
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What barriers, obstacles or challenges did you encounter?
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SOCIAL DETERMINANTS OF HEALTH Did race/ethnicity (i.e. implicit bias), language barrier, or specific social determinants of health contribute to the morbidity?
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Yes
No
Maybe
Describe any system changes that could be implemented that could alter the outcome?
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SUBSTANCE USE DISORDER CASE PRESENTATION Improving Perinatal Health ECHO is committed to reducing stigma and negative bias when discussing race, class, gender identity, sexual orientation, substance use, and mental health. By overcoming stigma, we work toward ending discrimination.
Equity Harm reduction Trauma- informed care Strength- based language Awareness of stigma and bias Avoiding perfectionism and cultivating authenticity and self-compassion Consider what other services and referrals a patient may benefit from, whether or not they are available in your community
Instead of... You can Say… Addict/Drug abuser/Junkie Person using substances Former addict Person in recovery Clean/Dirty Person testing positive/negative Schizophrenic, bipolar, borderline Person with (name of mental illness) Non-compliant/non-adherent She attends about half of her appointments Handicapped Person with a disability Female to male, male to female, transgendered Trans man, trans woman Substance abuse Substance use disorder Homeless Unhoused, precariously housed, person experiencing homelessness/unstable housing Prostitute Sex Worker, sex work/street economies Children being taken away Family experiencing CYFD involvement Going to jail Experienced incarceration, returning citizens
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Retrospective Case or Recommendation-Based
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This case is retrospective
This case relates to the care of a current patient and seeks recommendation from the network for continuing care
What are your specific question(s) about this case?
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Brief history of your interaction with the patient:
Did the patient receive prenatal care? Were there known barriers to receiving prenatal care?
What is the patients known substance use history?
Was the patient screened for SUD with a validated screening tool?
Yes
No
Please provide more information on the SUD screening:
Brief behavioral health history:
What is the known social history of the patient?(E.g. Social and family supports, housing status: [unhoused, transient, precarious housing, secure], experiences with incarceration, access to transportation,food insecurity, domestic violence, CYFD involvement, immigration status)
What pharmacological and non-pharmacological interventions were prescribed?
Did the patient receive Medication Assisted Treatment?
Yes
No
Yes
No
Was the patient counseled on harm reduction strategies?
Yes
No
What harm reduction strategies were shared with the patient?
Did the patient receive a Plan of Care?
Yes
No
Was there a warm handoff and was follow up care received?
Yes
No
Unknown
Please describe warm handoff and follow up care received:
Has the patient been offered a Plan of Care?
Yes
No
Do you know what the plan for handoff and follow up care looks like?
Reflecting on this case, is there evidence of stigma and bias that may have impacted the outcome?
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