Andrea Kuster (left), director of Obstetric MediCal Services, and nurse practitioner student Teaghe Yalon provide care to patient Areli Cortes. (Photography by Elisabeth Fall)
Expanded Partnership at UCSF to Advance Care for Publicly Insured Pregnant Patients
An expanded partnership at UCSF will strengthen the quality of care for more than 400 pregnant patients who are publicly insured and their newborn babies every year.
The partnership among the UCSF School of Nursing, the UCSF Health Office of Population Health and the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences comes at a time when perinatal outcomes are lagging across the country, particularly in low-income and underrepresented communities. Americans on public health insurance typically have access to fewer resources and are at higher risk for health problems.
UCSF has long provided care to publicly insured pregnant patients. The expanded partnership will enhance that care by delivering services that are more individualized and comprehensive.
Among the new components, the Office of Population Health team will serve as care managers who will follow patients from pregnancy to 60 days postpartum, and newborns from birth through entry into pediatric care.
“We have the opportunity to impact more MediCal patients, to provide more comprehensive services, and to ensure that patients are connected to resources in the community that outlast their time in prenatal care,” said Andrea Kuster, DNP, FNP, associate professor at the School of Nursing who will serve as director of Obstetric MediCal Services at UCSF Health.
The partnership builds off the success of the School of Nursing’s longstanding Young Women’s Clinic and leverages its best practices to provide improved patient care. The previous program name will be retired. There will be no new clinic name; instead, improved practices will be implemented across all of UCSF’s system of prenatal care delivery.
The collaboration with the Office of Population Health will allow UCSF to better track health outcomes for patients.
“UCSF Health will be able to monitor how well we are providing patient-centered care to publicly insured pregnant people,” said Gina Intinarelli-Schuler, PhD, RN, chief population health officer at UCSF Health and associate dean at the UCSF School of Nursing. “This is part of our commitment as an institution to improve the quality of life for this patient population, and the expertise the School of Nursing in contributing to the intended improvements is vital.”
Learners will continue to receive training in providing quality care to underserved patients in an interprofessional environment.
School of Nursing students will continue to work collaboratively with social workers, registered dietitians, other members of the clinical team and community resources. In addition, the team will continue to work with medical students, residents and other UCSF learners.
Kuster will lead the expanded partnership, in collaboration with Roxanna Irani, MD, PhD, ambulatory medical director for Women’s Health Services, and Megan Paul, BS, RN, administrative director of Obstetrics Clinic at UCSF Health.
“This expanded partnership represents UCSF’s vision for delivering excellence in care for underserved populations and to improve the health of the communities we serve,” said Anais Ryken, director of Women's Health Services.
50 Years of Patient Care, Nursing Education at Young Women's Clinic
For 50 years, the Young Women’s Clinic provided quality health care to hundreds of pregnant individuals, and included prenatal, postpartum, gynecologic, contraceptive and primary care services.
Its team was led by nurse practitioners who were accompanied by clinic staff, a nutritionist, social worker and a consultant physician, handling an average of 750 patient visits annually.
In addition to being the first faculty-led practice in the UCSF School of Nursing, it was the key clinical training ground for nursing students in the Women's Health Nurse Practitioner and Family Nurse Practitioner specialties. As many as 32 students a year completed their clinical residencies at the clinic, receiving hands-on training and health care delivery experience within an interprofessional team.
“Our faculty practice provided a valuable space to educate future nurse practitioners, role modeling evidence-based care and collaborative multidisciplinary practice and grounded in the medical as well as in the psychosocial and nutritional needs of the patients and their families,” said Pilar Bernal de Pheils, who joined the practice in 1992 and served as director from 2013 to 2018.
The clinic got its start in 1972 and was launched by former faculty members Ramona Mercer and Katharyn May.
The clinic’s work has generated research findings and papers aimed at advancing health care, especially for vulnerable populations, and broadening the understanding of nurse practitioners’ roles. For example, a 1983 paper by Mercer and May examined teen pregnancy outcomes from those undergoing care from nurse practitioners, and found that maternal outcomes for adolescents receiving antepartum care at the Young Women’s Clinic was higher than at other clinics.
Over its five-decade tenure, the clinic called several locations home including the UCSF Ambulatory Care Center, Mount Zion Pediatrics, Women’s Community Clinic and, most recently, the UCSF Women’s Health Center at Mount Zion.
Past directors included Diana Taylor, Lisa Lommel, Jean Neeson, Kathy Patterson, Ellen Scarr, Milan Chavarkar, Jerusalem Makonnen, Bernal de Pheils and Andrea Kuster.
Lommel, a former student and director of the clinic, reflected on the clinic’s legacy: “The YWC was one of the few clinics in San Francisco that offered an evidence-based, caring and safe space for birthing adolescents to learn about the experience of pregnancy and delivery through empowerment and trust. It was one of the first all advanced practice provider (APP) clinics at UCSF and the first where APPs shared revenue with the health center.”
