The fetal alert network: an innovative program of access to care, surveillance, and education for birth defects in Ontario.

Optimal pregnancy outcomes rely on coordinated timely access to appropriate evidence-based clinical care. This is particularly true for pregnant women carrying fetuses diagnosed with birth defects. A systematic approach to prenatal care is ideal, but Ontario has traditionally lagged behind other regions in this regard. In 2004, in response to this challenge, the Fetal Alert Network (FAN) was established with funding support from the Ontario Ministry of Health and Long-Term Care. FAN is composed of five multidisciplinary regional health care teams of nurse coordinators working in close collaboration with primary obstetrical care providers, medical geneticists, specialists in maternal fetal medicine, and pediatric specialists. The teams facilitate access to subspecialists through patient triage and referral, provide outreach education, and act as local experts and change agents to improve care. A key objective is to go beyond a traditional surveillance system to the linkage of service provision with outcomes and effectiveness. FAN's objectives are to ensure optimal health care access and delivery at all levels, to promote coordination and collaboration among providers, to provide timely and accurate information about health system utilization and clinical outcomes, and to educate patients and primary care providers about prenatal diagnosis. Program evaluation is currently underway. Preliminary analyses indicate that achievement of these objectives has resulted in seamless coordinated access to service for the targeted group of patients, as well as enhanced communication among providers; accessible education and information; and precise, accurate, and timely health care data and information.