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Meghea CI, Raffo JE, Yu X, Meng R, Luo Z, Vander Meulen P, Sanchez Lloyd C, Roman LA. Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance. JAMA Pediatr 2023; 177:939-946. [PMID: 37486641 PMCID: PMC10366943 DOI: 10.1001/jamapediatrics.2023.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 07/25/2023]
Abstract
Importance Home visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities. Objective To assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid. Design, Setting, and Participants This retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023. Exposure Participation in Strong Beginnings or usual care. Main Outcomes and Measures Preterm birth (less than 37 weeks' gestation at birth), very preterm birth (less than 32 weeks' gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days). Results A total of 125 252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124 166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14 984 of 124 166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (-2.2%; 95% CI, -4.1 to -0.3), very preterm birth (-1.2%; 95% CI, -2.0 to -0.4), very low birth weight (-0.8%; 95% CI, -1.3 to -0.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]). Conclusions and Relevance Participation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals.
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Affiliation(s)
- Cristian I. Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing
| | - Jennifer E. Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing
| | - Xiao Yu
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing
| | - Ran Meng
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Peggy Vander Meulen
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Celeste Sanchez Lloyd
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing
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Liu J, Zhao L, Zhao X, Bawa EM, Alston K, Karim S, Merchant AT, Tang J, Wilcox S. Impact of a Large Healthy Start Program on Perinatal Outcomes, South Carolina, 2009-2019. Am J Public Health 2023; 113:509-513. [PMID: 36893369 PMCID: PMC10088942 DOI: 10.2105/ajph.2023.307232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Using linked birth and death certificates for participants served by a Healthy Start program in South Carolina and community controls, we found that the Healthy Start program contributed to significant improvements in prenatal care, breastfeeding initiation, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children and significant reductions in inadequate weight gain and large-for-gestational-age births. However, Healthy Start participants were more likely to gain excessive weight during pregnancy, and there were no significant differences in perinatal outcomes. (Am J Public Health. Published online ahead of print March 9, 2023:e1-e5. https://doi.org/10.2105/AJPH.2023.307232).
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Affiliation(s)
- Jihong Liu
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Longgang Zhao
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Xingpei Zhao
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Eric Mishio Bawa
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Kimberly Alston
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Sabrina Karim
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Anwar T Merchant
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jun Tang
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Sara Wilcox
- Jihong Liu, Longgang Zhao, Xingpei Zhao, Eric Mishio Bawa, Sabrina Karim, and Anwar T. Merchant are with the Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Kimberly Alston is with Midlands Healthy Start, Prisma Health, Columbia, SC. Jun Tang is with the Division of Biostatistics, South Carolina Department of Health and Environmental Control, Columbia. Sara Wilcox is with the Department of Exercise Science and the Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
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Vladutiu CJ, Mobley SC, Ji X, Thomas S, Kandasamy V, Sutherland D, Inglett S, Li R, Cox S. A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS, Birth Records and Program Data. Matern Child Health J 2021; 25:1516-1525. [PMID: 34417685 PMCID: PMC10425706 DOI: 10.1007/s10995-021-03205-4] [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: 08/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation. METHODS ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes. RESULTS 107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes. DISCUSSION Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration (HRSA), Rockville, MD, USA.
| | - Sandra C Mobley
- Department of Obstetrics & Gynecology (Retired), Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Suzanne Thomas
- CSRA Nursing Associates, PC and Augusta University College of Nursing (Adjunct), Augusta, GA, USA
| | - Veni Kandasamy
- Oak Ridge Institute for Science and Education, Oak Ridge Affiliated Universities, Oak Ridge, TN, USA
| | - Don Sutherland
- Enterprise Community Healthy Start, The Perinatal Center, Augusta University, Augusta, GA, USA
| | - Sandra Inglett
- Enterprise Community Healthy Start, College of Nursing, Augusta University, Augusta, GA, USA
| | - Rui Li
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Shanna Cox
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
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D'haenens F, Helsloot K, Lauwaert K, Agache L, de Velde GV, De Frène V, Embo M, Vermeulen J, Beeckman K, Fobelets M. Towards an integrated perinatal care pathway for vulnerable women: The development and validation of quality indicators. Midwifery 2020; 89:102794. [PMID: 32668387 DOI: 10.1016/j.midw.2020.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Development and validation of a set of quality indicators for vulnerable women during the perinatal period. DESIGN A three-phase method was used. Phase 1 consisted of a literature review to identify publications for the development of care domains and potential QIs, as well as a quality assessment by the research team. In phase 2 an expert panel assessed the set of concept QIs in a modified three-round Delphi survey. Finally, semi-structured interviews with vulnerable women were conducted as a final quality assessment of a set of indicators (phase 3). Ethical approval was obtained from the ethics committee of the University Hospital Brussels and from the Ethics Committees of all the participating hospitals. SETTING The Flemish Region and the Brussels Capital Region in Belgium. PARTICIPANTS Healthcare and social care professionals (n = 40) with expertise in the field of perinatal care provision for vulnerable families. Vulnerable women (n = 11) who gave birth in one of the participating hospitals. FINDINGS The literature review resulted in a set of 49 potential quality indicators in five care domains: access to healthcare, assessment and screening, informal support, formal support and continuity of care. After assessment by the expert panel and vulnerable women, a final set of 21 quality indicators in five care domains was identified. First of all, organisation of care must involve an integrated multidisciplinary approach taking account of financial, administrative and social barriers (care domain 1: access to healthcare). Second, qualitative care includes the timely initiation of care, a general screening of the various aspects of vulnerability (biological, psychological, social and cognitive) and a risk assessment for all women (care domain 2: assessment and screening). Vulnerable women benefit from intensive formal and informal support taking account of individual needs and strengths (care domain 3: formal support; care domain 4: informal support). Finally, continuity of care needs to be guaranteed in line with vulnerable woman's individual needs (care domain 5: continuity of care). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Implementing quality indicators in existing and new care pathways offers an evidence-based approach facilitating an integrated view promoting a healthy start for woman and child. These quality indicators can assist healthcare providers, organisations and governmental agencies to improve the quality of perinatal care for vulnerable women.
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Affiliation(s)
- Florence D'haenens
- Midwifery Department, Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Belgium.
| | - Kaat Helsloot
- Midwifery Department, Artevelde University of Applied Sciences, Ghent, Belgium.
| | - Karen Lauwaert
- Midwifery Department, Artevelde University of Applied Sciences, Ghent, Belgium.
| | - Lien Agache
- Social Care Department, Artevelde University of Applied Sciences, Ghent, Belgium.
| | - Griet Van de Velde
- Midwifery Department, Artevelde University of Applied Sciences, Ghent, Belgium; Midwifery Department, Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Belgium.
| | - Veerle De Frène
- Midwifery Department, Artevelde University of Applied Sciences, Ghent, Belgium.
| | - Mieke Embo
- Midwifery Department, Artevelde University of Applied Sciences, Ghent, Belgium.
| | - Joeri Vermeulen
- Midwifery Department, Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Belgium; Department of Public Health, Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium.
| | - Katrien Beeckman
- University Hospital Brussels, Nursing and Midwifery Research Unit, Belgium; Vrije Universiteit Brussel (VUB), Nursing and Midwifery Research Unit, Faculty of Medicine and Pharmacy & Universitair Ziekenhuis Brussel, Belgium; Verpleeg- en vroedkunde, Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Universiteit Antwerpen, Belgium.
| | - Maaike Fobelets
- Department of Public Health, Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium; Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Belgium.
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Montoya-Williams D, Bright M, Martinez S, Echavarria M, Mercado R, Lorch S, Thompson L. Associations Between a Healthy Start Program Prenatal Risk Screening Tool and Adverse Birth Outcomes: A Study Using the Mother/Infant Dyad Screening Cohort. J Womens Health (Larchmt) 2020; 29:647-655. [PMID: 31895651 DOI: 10.1089/jwh.2019.7712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Florida's Healthy Start Program is a statewide prenatal screening program that aims to identify pregnant women at risk of adverse birth outcomes. However, the effectiveness of this legislatively mandated prenatal risk screening tool in predicting poor birth outcomes is unknown. This study aimed to evaluate associations between risk factors self-reported on this screening tool and adverse birth outcomes. Materials and Methods: A 1-year retrospective birth cohort at a large academic referral center was created. Risk factors reported on the tool by mothers who had a preterm or low-birthweight (LBW) infant were compared with those reported by mothers who delivered full-term non-LBW infants in bivariate and multivariate analyses. All data were extracted from maternal or infant electronic health records. Results: The Mother/Infant Dyad Screening cohort consisted of 528 dyads. We identified two items on the screening tool that significantly associated with adverse birth outcomes, but which do not currently contribute to the total risk score used to identify women for referral to preventive social services. These items were feeling alone and thinking it was not a good time to be pregnant. Conclusions: Comprehensive prenatal risk screening is an underutilized strategy in medicine. Florida's mandatory self-reported, prenatal survey can identify women at risk for poor neonatal outcomes. A more nuanced understanding how women are interpreting survey items and a re-evaluation of scoring practices may allow the tool to better serve as a model for other programs seeking to identify pregnant women at risk of poor birth outcomes.
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Affiliation(s)
- Diana Montoya-Williams
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Bright
- Anita Zucker Center for Excellence in Early Childhood Studies, Gainesville, Florida
| | - Silvio Martinez
- College of Medicine, University of Florida, Gainesville, Florida
| | - Maria Echavarria
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Rebeccah Mercado
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Scott Lorch
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay Thompson
- Department of Pediatrics and University of Florida, Gainesville, Florida.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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Effects of recruiting midwives into family physician program on the percentage of low birth weight (LBW) infants in rural areas of Kurdistan. Med J Islam Repub Iran 2017; 31:92. [PMID: 29951393 PMCID: PMC6014774 DOI: 10.14196/mjiri.31.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background: LBW is an important factor that can affect infant mortality and represents an index of economic and social development.
It is expected that an increase in the density of midwives attending family physician programs will lead to a decrease in LBW in
health centers. This study aimed to compare the percentage of LBW infants before and after the implementation of the family physician
program in health centers with and without an increase in midwives density.
Methods: This cross-sectional study compared the percentage of LBW infants before and after the implementation of family physician
programs in rural health centers with and without changes in midwives density in Kurdistan. In this study, we included 668 mothers
of 2-month-old children and administered structured interviews in 2005 and 2013. Data were analyzed using the difference-indifferences
and the Matchit statistical models.
Results: The Matchit model showed a significant average percentage increase 0.08 (0.006–0.17) in LBW infants born between 2005
and 2013 in health centers where the density of midwives increased compared with those where it remained unchanged. The difference-in-differences
model showed that the odds ratio of LBW infants is increased by more than twice among participants who had a
history of caesarean section.
Conclusion: The results of this study showed that an increase in the density of midwives in a family physician program did not have
an impact on reducing the percentage of LBW infants born between 2005 and 2013, in health centers where the density of midwives
augmented compared to those where it remained unaltered; it indicated that the increase in the density of midwives alone was not efficient.
On the other hand, the results of our study show an increase in the risk of infants born at a LBW due to caesarean section. It is
recommended that obstetricians and gynecologists must strictly control pregnancies and avoid unnecessary termination of pregnancy
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Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. CHILD ABUSE & NEGLECT 2016; 53:64-80. [PMID: 26724823 DOI: 10.1016/j.chiabu.2015.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/05/2015] [Indexed: 06/05/2023]
Abstract
In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results.
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Affiliation(s)
- Katherine L Casillas
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, USA
| | - Angèle Fauchier
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, USA
| | - Bridget T Derkash
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, USA
| | - Edward F Garrido
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, USA
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Vos AA, Leeman A, Waelput AJ, Bonsel GJ, Steegers EA, Denktaş S. Assessment and care for non-medical risk factors in current antenatal health care. Midwifery 2015; 31:979-85. [DOI: 10.1016/j.midw.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/27/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
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Ichikawa K, Fujiwara T, Nakayama T. Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes. PLoS One 2015; 10:e0137307. [PMID: 26348847 PMCID: PMC4562632 DOI: 10.1371/journal.pone.0137307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health. PURPOSE To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes. METHODS In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old), women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964), which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311) and included in the analysis. Data were analyzed between January and June 2014. RESULTS In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98) and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92) compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5). CONCLUSION Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.
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Affiliation(s)
- Kayoko Ichikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Meghea CI, Raffo JE, VanderMeulen P, Roman LA. Moving toward evidence-based federal Healthy Start program evaluations: accounting for bias in birth outcomes studies. Am J Public Health 2013; 104 Suppl 1:S25-7. [PMID: 24354826 DOI: 10.2105/ajph.2013.301276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used administrative and screening data from 2009 to 2010 to determine if Healthy Start (HS), an enhanced prenatal services program, is reaching the most vulnerable African American women in Kent County, Michigan. Women in HS are at higher risk of key predictors of birth outcomes compared with other women. To advance toward evidence-based HS program evaluations in the absence of randomized controlled trials, future studies using comparison groups need to appropriately establish baseline equivalence on a variety of risk factors related to birth outcomes.
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Affiliation(s)
- Cristian I Meghea
- Cristian I. Meghea, Jennifer E. Raffo, and Lee Anne Roman are with the Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing. Cristian I. Meghea is also with the Institute for Health Policy, Michigan State University. Peggy VanderMeulen is with Strong Beginnings Federal Healthy Start Program, Spectrum Health, Grand Rapids, MI
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