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Mallinson DC, Gillespie KH. Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010-2019. J Community Health 2024; 49:732-747. [PMID: 38407757 PMCID: PMC11305971 DOI: 10.1007/s10900-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes-namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during 2010-2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach.
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Affiliation(s)
- David C Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way, STE 200, Madison, WI, 53705, USA.
| | - Kate H Gillespie
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, WI, 53705, USA
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Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. FRONTIERS IN HEALTH SERVICES 2023; 3:1211577. [PMID: 37654810 PMCID: PMC10465329 DOI: 10.3389/frhs.2023.1211577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Abstract
Background For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.
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Affiliation(s)
- Denise M. Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Dylan Waller
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Kristina M. Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn M. McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Perla
- Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States
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Mallinson DC, Elwert F, Ehrenthal DB. Spillover Effects of Prenatal Care Coordination on Older Siblings Beyond the Mother-Infant Dyad. Med Care 2023; 61:206-215. [PMID: 36893405 PMCID: PMC10009763 DOI: 10.1097/mlr.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Pregnancy care coordination increases preventive care receipt for mothers and infants. Whether such services affect other family members' health care is unknown. OBJECTIVE To estimate the spillover effect of maternal exposure to Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during pregnancy with a younger sibling on the preventive care receipt for an older child. RESEARCH DESIGN Gain-score regressions-a sibling fixed effects strategy-estimated spillover effects while controlling for unobserved family-level confounders. SUBJECTS Data came from a longitudinal cohort of linked Wisconsin birth records and Medicaid claims. We sampled 21,332 sibling pairs (one older; one younger) who were born during 2008-2015, who were <4 years apart in age, and whose births were Medicaid-covered. In all, 4773 (22.4%) mothers received PNCC during pregnancy with the younger sibling. MEASURES The exposure was maternal PNCC receipt during pregnancy with the younger sibling (none; any). The outcome was the older sibling's number of preventive care visits or preventive care services in the younger sibling's first year of life. RESULTS Overall, maternal exposure to PNCC during pregnancy with the younger sibling did not affect older siblings' preventive care. However, among siblings who were 3 to <4 years apart in age, there was a positive spillover on the older sibling's receipt of care by 0.26 visits (95% CI: 0.11, 0.40 visits) and by 0.34 services (95% CI: 0.12, 0.55 services). CONCLUSION PNCC may only have spillover effects on siblings' preventive care in selected subpopulations but not in the broader population of Wisconsin families.
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Affiliation(s)
- David C. Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Felix Elwert
- Department of Sociology, College of Letters and Sciences, University of Wisconsin-Madison, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
- Center for Demography and Ecology, University of Wisconsin-Madison, United States
| | - Deborah B. Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, United States
- Social Science Research Institute, Pennsylvania State University, University Park, Pennsylvania, United States
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Garite TJ, Manuck TA. Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth? Am J Obstet Gynecol 2022; 228:430-437. [PMID: 36130634 PMCID: PMC10024643 DOI: 10.1016/j.ajog.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine. However, it has not made its way into the general lexicon and practice of obstetrical care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in nor is it advocated for as a recommended prematurity prevention approach in the American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.
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Affiliation(s)
- Thomas J Garite
- Sera Prognostics, Salt Lake City, UT; University of California Irvine, Irvine, CA.
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Chou CC, Liaw JJ, Chen CC, Liou YM, Wang CJ. Effects of a Case Management Program for Women With Pregnancy-Induced Hypertension. J Nurs Res 2021; 29:e169. [PMID: 34432727 DOI: 10.1097/jnr.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pregnancy-induced hypertension (PIH) is a leading cause of maternal and fetal morbidity and mortality. Although case management programs have been proposed to improve maternal and fetal outcomes in high-risk pregnancies, limited data are available regarding the effect of case management on women with PIH. PURPOSE The aim of this study was to evaluate the effect of an antepartum case management program on stress, anxiety, and pregnancy outcomes in women with PIH. METHODS A quasi-experimental research design was employed. A convenience sample of women diagnosed with PIH, including preeclampsia, was recruited from outpatient clinics at a medical center in southern Taiwan. Sixty-two women were assigned randomly to either the experimental group (n = 31) or the control group (n = 31). The experimental group received case management for 8 weeks, and the control group received routine clinical care. Descriptive statistics, independent t or Mann-Whitney U tests, chi-square or Fisher's exact tests, paired t test, and generalized estimating equations were used to analyze the data. RESULTS The average age of the participants was 35.1 years (SD = 4.5). No significant demographic or clinical differences were found between the control and experimental groups. The results of the generalized estimating equations showed significantly larger decreases in stress and anxiety in the experimental group than in the control group. No significant differences were identified between the two groups with respect to infant birth weeks, infant birth weight, average number of medical visits, or frequency of hospitalization. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The nurse-led case management program was shown to have short-term positive effects on the psychosocial outcomes of a population of Taiwanese patients with PIH. These results have important clinical implications for the healthcare administered to pregnant women, particularly in terms of improving the outcomes in those with PIH.
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Affiliation(s)
- Cheng-Chen Chou
- PhD, RN, Assistant Professor, Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- PhD, RN, Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chuan-Chuan Chen
- BSN, RN, Case Manager, Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yiing-Mei Liou
- PhD, RN, Distinguished Professor, Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jane Wang
- PhD, RN, Associate Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and National Cheng Kung University Hospital, Tainan, Taiwan
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Mallinson DC, Larson A, Berger LM, Grodsky E, Ehrenthal DB. Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixed effects analysis. Health Serv Res 2020; 55:82-93. [PMID: 31701531 PMCID: PMC6980950 DOI: 10.1111/1475-6773.13239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid-covered deliveries. DATA SOURCE A longitudinal cohort of linked Wisconsin birth records (2008-2012), Medicaid claims, and state-administered social services. STUDY DESIGN We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500 g), gestational age (completed weeks), and preterm birth (<37 weeks). We estimated PNCC's effect on birth outcomes, adjusting for maternal characteristics, using inverse-probability of treatment weighted and sibling fixed effects regressions. DATA COLLECTION/EXTRACTION METHODS We identified 136 224 Medicaid-paid deliveries, of which 33 073 (24.3 percent) linked to any PNCC claim and 22 563 (16.6 percent) linked to claims for PNCC service uptake. PRINCIPAL FINDINGS Sibling fixed effects models-which best adjust for unobserved confounding and treatment selection-produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P < .05). CONCLUSIONS PNCC's modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.
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Affiliation(s)
- David C. Mallinson
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Andrea Larson
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
| | | | - Eric Grodsky
- Department of SociologyCollege of Letters & ScienceUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Educational Policy StudiesSchool of EducationUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Deborah B. Ehrenthal
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
- Department of Obstetrics and GynecologySchool of Medicine & Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin
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7
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Park YJ, Weinberg S, Cogan LW. The impact of the Medicaid high-risk ob care management program in New York State. Health Serv Res 2019; 55:71-81. [PMID: 31713854 DOI: 10.1111/1475-6773.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine the effect of high-risk obstetrics (HROB) care management on infant health and Medicaid expenditures. DATA SOURCES/STUDY SETTING Medicaid administrative data and vital statistics from 2011 to 2013. In New York State, all Medicaid managed care plans provide HROB care management to their members. STUDY DESIGN We conducted a retrospective cohort study with a nonequivalent control group. Selection bias was addressed by using probit and OLS models with the Heckman correction and inverse probability weight with regression adjustment. PRINCIPAL FINDINGS While program enrollment was associated with poor infant health outcomes (low birthweight, very low birthweight, preterm delivery, and gestational age), correcting for sample selection substantially improved most of these outcomes. All infant health outcomes significantly improved as the number of weeks in the program increased. We found that a 1-week increase in program duration is associated with a 0.01 percentage point decrease in low birthweight and a 0.03 percentage point decrease in very low birthweight. Further, a 1-week increase in program duration decreases the probability of preterm delivery by 0.01 percentage points and increases gestational age by 0.14 days. Medicaid expenditures for maternity care and newborn delivery were not significantly or materially affected by program enrollment or program duration. CONCLUSIONS High-risk obstetrics care management appears to successfully identify individuals with high-risk pregnancies and improve health without substantially increasing medical expenses.
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Affiliation(s)
- Young Joo Park
- School of Public Administration, University of New Mexico, Albuquerque, New Mexico
| | - Stephen Weinberg
- Rockefeller College of Public Affairs and Policy, University at Albany-State University of New York, Albany, New York
| | - Lindsay W Cogan
- New York State Department of Health, Albany, New York.,School of Public Health, University at Albany-State University of New York, Albany, New York
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Larson A, Berger LM, Mallinson DC, Grodsky E, Ehrenthal DB. Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context. J Community Health 2019; 44:32-43. [PMID: 30022418 PMCID: PMC6330123 DOI: 10.1007/s10900-018-0550-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among those assessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCC services. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination's effects on birth outcomes should account for service context and the treatment level into which participants select.
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Affiliation(s)
- Andrea Larson
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lawrence M Berger
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - David C Mallinson
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric Grodsky
- Sociology and Educational Policy Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Dauber S, John T, Hogue A, Nugent J, Hernandez G. Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients. CHILDREN AND YOUTH SERVICES REVIEW 2017; 81:157-167. [PMID: 29249846 PMCID: PMC5729752 DOI: 10.1016/j.childyouth.2017.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Perinatal maternal depression (MD), substance use (SU), and intimate partner violence (IPV) are critical public health concerns with significant negative impacts on child development. Bolstering the capacity of home visiting (HV) programs to address these significant risk factors has potential to improve child and family outcomes. This study presents a description and mixed-methods feasibility evaluation of the "Home Visitation Enhancing Linkages Project (HELP)," a screen-and-refer approach to addressing MD, SU, and IPV within HV aimed at improving risk identification and linkage to treatment among HV clients. HELP was a three-phase intervention that included three evidence-based interventions: screening, motivational interviewing (MI), and case management (CM). This study presents quantitative fidelity data from 21 home visitors reporting on 116 clients in 4 HV programs, as well as qualitative data from structured interviews with 14 home visitors. Nearly all clients were screened and 22% screened positive on at least one risk domain. Rates of MI and CM implementation were lower than expected, however home visitors implemented general supportive interventions at high rates. Home visitor interviews revealed the following factors that may have impacted HELP implementation: client disclosure of risk, barriers to treatment access, systems integration, home visitor role perception, and integration of HELP into the broader HV curriculum. Implications of study findings for the design of future attempts to address maternal risk within HV are discussed.
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Affiliation(s)
- Sarah Dauber
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Tiffany John
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Aaron Hogue
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Jessica Nugent
- Prevent Child Abuse New Jersey, 103 Church Street, New Brunswick, NJ 08901, United States
| | - Gina Hernandez
- Prevent Child Abuse New Jersey, 103 Church Street, New Brunswick, NJ 08901, United States
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10
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Loftus CT, Stewart OT, Hensley MD, Enquobahrie DA, Hawes SE. A Longitudinal Study of Changes in Prenatal Care Utilization Between First and Second Births and Low Birth Weight. Matern Child Health J 2016; 19:2627-35. [PMID: 26138322 DOI: 10.1007/s10995-015-1783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Because previous analyses of prenatal care (PNC) utilization and risk of low birth weight (LBW) may have been influenced by selection bias, we conducted a study using longitudinal data of women with repeat pregnancies. METHODS We analyzed Washington State birth certificates of first and second live births (2003-2012). We estimated relative risk (RR) of LBW at second birth associated with Kotelchuck Index PNC level among women stratified by level of PNC in their first birth (n = 67,571). RESULTS Among women with inadequate PNC prior to their first birth (n = 10,355), women with intermediate or adequate PNC before their second birth (n = 7464) had a reduced risk of LBW (adjusted RR 0.61, 95% CI: 0.48, 0.78) compared to those whose PNC level remained inadequate. Likewise, among women with intermediate or adequate PNC prior to their first birth (n = 57,216), those with inadequate PNC before the second birth (n = 7095) had higher risk of LBW (adjusted RR 1.59, 95% CI: 1.36, 1.85) compared to those who remained at intermediate or adequate PNC. CONCLUSIONS Our findings support the hypothesis that PNC decreases LBW risk at second birth, independent of factors related to the utilization of PNC at first birth.
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Affiliation(s)
- Christine T Loftus
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Orion T Stewart
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA.
| | - Mark D Hensley
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
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11
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Whitley DM, Lamis DA, Kelley SJ. Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren. J Clin Psychol 2016; 72:563-79. [PMID: 26918307 DOI: 10.1002/jclp.22272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/13/2015] [Accepted: 12/20/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. METHOD A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model. RESULTS Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups. CONCLUSION The findings suggest appropriate resource-focused interventions can enhance grandmothers' subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings.
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Affiliation(s)
| | - Dorian A Lamis
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences/Grady Health System, Atlanta, GA
| | - Susan J Kelley
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA
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12
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Improving Medicaid: three decades of change to better serve women of childbearing age. Clin Obstet Gynecol 2016; 58:336-54. [PMID: 25860326 DOI: 10.1097/grf.0000000000000115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Over the past 3 decades, major changes enhanced Medicaid's role in improving the health of women and perinatal outcomes. Reforms in the 1980s and 1990s had impact not only on coverage but also on current policy debates. Whether or not states expand eligibility under the Affordable Care Act, Medicaid is important. Increased coverage for well-woman visits, preconception care, and contraceptive methods are opportunities in gynecology. As a critical source of maternity coverage, Medicaid can improve prenatal care, reduce preterm births, limit early elective deliveries, and increase postpartum visits. Obstetrician-gynecologists play a role in translating coverage into access to quality services.
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13
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Whitley DM, Kelley SJ, Lamis DA. Depression, Social Support, and Mental Health: A Longitudinal Mediation Analysis in African American Custodial Grandmothers. Int J Aging Hum Dev 2016; 82:166-87. [PMID: 26798077 DOI: 10.1177/0091415015626550] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Custodial grandparents raising grandchildren experience intense levels of stress that can lead to depression and other forms of psychological distress. Drawing on a coping model of family stress, adjustment, and adaptation, we explored the relationship between depression and mental health quality of life mediated by social support and moderated by grandparent's age. The sample consisted of 667 African American custodial grandmothers, dichotomized into two age groupings, ≤55 (n = 306) and 55 + (n = 361). All grandmothers participated in a 12-month support intervention. The prospective analysis revealed social support was a mediator in the association between depressive symptoms and mental health quality of life for older African American grandmothers; however, this same relationship did not hold for their younger counterparts. Study limitations and future research directions are discussed.
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Affiliation(s)
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences/Grady Health System, Emory University School of Medicine, Atlanta, GA, USA
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14
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Improving Pregnancy Outcomes through Maternity Care Coordination: A Systematic Review. Womens Health Issues 2016; 26:87-99. [DOI: 10.1016/j.whi.2015.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
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Abstract
BACKGROUND MOMS Orange County is a coordinated home visitation program in which trained paraprofessional home visitors work under the close supervision of registered nurses. This model was developed to address health disparities in birth outcomes in a Hispanic community in Orange County, CA. PURPOSE The primary objective was to test the impact of MOMS Orange County on birth outcomes. The second objective was to examine the breadth of prenatal health education topics as a mediator of the relationship between home visits and birth outcomes. METHODS A retrospective cohort design was used. Paraprofessional home visitors collected prenatal and postnatal data during home visits. Only those whose birth outcomes were obtained were included in the analysis (N = 2,027 participants). Regression models were conducted to test the associations between prenatal home visits and birth outcomes, adjusting for 10 covariates. RESULTS Number of prenatal home visits predicted higher birthweight and greater gestational age at birth. Breadth of health education topics partially mediated the associations between home visits and birthweight. The same mediation was revealed with gestational age at birth. CLINICAL IMPLICATIONS The MOMS Orange County prenatal home visitation program may be a promising approach to decrease adverse birth outcomes in disadvantaged communities. Rigorously designed studies are needed to further test this model.
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Meghea CI, You Z, Raffo J, Leach RE, Roman LA. Statewide Medicaid Enhanced Prenatal Care Programs and Infant Mortality. Pediatrics 2015; 136:334-42. [PMID: 26148955 DOI: 10.1542/peds.2015-0479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate whether participation in a statewide enhanced prenatal and postnatal care program, the Maternal Infant Health Program (MIHP), reduced infant mortality risk. METHODS Data included birth and death records, Medicaid claims, and program participation. The study population consisted of Medicaid-insured singleton infants born between January 1, 2009, and December 31, 2012, in Michigan (n = 248 059). The MIHP participants were propensity score-matched with nonparticipants based on demographics, previous pregnancies, socioeconomic status, and chronic disease. Infant mortality, neonatal mortality, and postneonatal mortality analyses were presented by race. RESULTS Infants with any MIHP participation had reduced odds of death in the first year of life compared with matched nonparticipants (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.63-0.84). Infant death odds were reduced both among black infants (OR 0.71, 95% CI 0.58-0.87) and infants of other races (OR 0.74, 95% CI 0.61-0.91). Neonatal death (OR 0.70, 95% CI 0.57-0.86) and postneonatal death odds (OR 0.78, 95% CI 0.63-0.96) were also reduced. Enrollment and screening in MIHP by the end of the second pregnancy trimester and at least 3 additional prenatal MIHP contacts reduced infant mortality odds further (OR 0.70, 95% CI 0.58-0.85; neonatal: OR 0.67, 95% CI 0.51-0.89; postneonatal: OR 0.74, 95% CI 0.56-0.98). CONCLUSIONS A state Medicaid-sponsored population-based home-visitation program can be a successful approach to reduce mortality risk in a diverse, disadvantaged population. A likely mechanism is the reduction in the risk of adverse birth outcomes, consistent with previous findings on the effects of the program.
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Affiliation(s)
- Cristian I Meghea
- Institute for Health Policy, Michigan State University; Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Babes-Bolyai University, Cluj-Napoca, Romania;
| | - Zhiying You
- Institute for Health Policy, Michigan State University
| | - Jennifer Raffo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Richard E Leach
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Spectrum Health System, Grand Rapids, Michigan
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Spectrum Health System, Grand Rapids, Michigan
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Adolescent and Adult Clients in Prenatal Case Management: Differences in Problems and Interventions Used. Matern Child Health J 2015; 19:2673-81. [DOI: 10.1007/s10995-015-1789-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Meghea CI, You Z, Roman LA. A Statewide Medicaid Enhanced Prenatal and Postnatal Care Program and Infant Injuries. Matern Child Health J 2015; 19:2119-27. [PMID: 25662845 DOI: 10.1007/s10995-015-1724-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To compare infant injuries in the first year of life between Maternal Infant Health Program (MIHP) participants and matched comparison groups. The population was the cohort of Medicaid-insured singleton infants born in 2011 in Michigan who had continuous Medicaid insurance and survived the first year after birth (N = 51,078). Propensity score matching was used to compare participants in MIHP to matched comparison groups from among the nonparticipants. Injury episodes were defined based on Medicaid claims in the first year of life. Matched comparisons were performed using McNemar, Bowker, and Wilcoxon signed rank tests to assess the effects of program participation on infant injuries. Infants of MIHP participants were more likely to have injury episodes (11.7 vs. 10.4 %, p < 0.01) and a higher rate of episodes (126.9/1,000 infants vs. 109.6/1,000) compared to matched nonparticipants. Infants of MIHP participants were more likely to have superficial injuries (4.9 vs. 3.9 %, p < 0.01) and a higher rate of episodes related to superficial injuries (49.7/1,000 vs. 39.6/1,000), which mainly accounted for the difference in injury visits between groups. Similar results were found among those enrolled and risk-screened in the program by the 2nd pregnancy trimester and who received a dosage of at least three additional MIHP contacts when compared to matched nonparticipants. MIHP participants did not experience reductions in infant injuries in the first year of life compared to matched nonparticipants. Possible explanations may include increased health-seeking behavior of the mothers participating in MIHP or improved recognition of infant injuries that warrant medical attention.
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Affiliation(s)
- Cristian I Meghea
- Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, MI, USA. .,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Fee Hall, 965 Fee RD, Room A632B, East Lansing, MI, 48824, USA. .,Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.
| | - Zhiying You
- Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Fee Hall, 965 Fee RD, Room A632B, East Lansing, MI, 48824, USA.,Department of Obstetrics, Gynecology, and Women's Health, Spectrum Health, Grand Rapids, MI, USA
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Medicaid home visitation and maternal and infant healthcare utilization. Am J Prev Med 2013; 45:441-7. [PMID: 24050420 DOI: 10.1016/j.amepre.2013.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/05/2013] [Accepted: 05/22/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Michigan Maternal and Infant Health Program (MIHP) is a population-based home-visitation program providing care coordination, referrals, and visits based on a plan of care. MIHP is available to all Medicaid-eligible pregnant women and infants aged ≤1 year in Michigan. PURPOSE To assess the effects of MIHP participation on maternal and infant healthcare utilization. METHODS Propensity-score matching methods were used to assess differences in healthcare utilization between MIHP participants and nonparticipants using 2009-2010 Medicaid claims and administrative data obtained from the Michigan Department of Community Health. Data were analyzed between October 2011 and March 2013. RESULTS MIHP participants had higher odds of receiving any prenatal care compared to matched women not participating in MIHP (OR=2.94, 95% CI=2.43, 3.60) and higher odds of receiving adequate prenatal care (OR=1.06, 95% CI=1.01, 1.11). MIHP participants had higher odds of receiving an appropriately timed postnatal visit (OR=1.50, 95% CI=1.43, 1.57). Infants participating in MIHP had higher odds of receiving any well-child visits over the first year of life (OR=1.70, 95% CI=1.51, 1.93) and higher odds of receiving the appropriate number of well-child visits over their first year of life (OR=1.47, 95% CI=1.35, 1.60) compared to matched nonparticipant infants. CONCLUSIONS The results from Michigan provide strong evidence for the effectiveness of a Medicaid-sponsored population-based home-visitation program in improving maternal prenatal and postnatal care and infant care. This evidence is important to consider as the federal healthcare reform is implemented and states are making decisions on the expansion of the Medicaid program.
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