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Linking Clinical and Public Health Approaches to Improve Access to Health Care for Socially Disadvantaged Mothers and Children: A Feasibility Study

Linking Clinical and Public Health Approaches to Improve Access to Health Care for Socially... Abstract Objective: To test the feasibility of combining home-and office-based interventions to improve access to health care and health outcomes of Medicaid-eligible mothers and infants. Design: Randomized trial in 2 counties in North Carolina (1 rural, 1 urban). Information on health and developmental outcomes was obtained by face-to-face interviews, medical chart abstractions, hospital medical records, and state data tapes. Participants: Ninety-three Medicaid-eligible first-time pregnant women in their third trimester and their subsequently born infants, who were followed up until they were 6 months old, and 3 pediatric practices and 1 family practice. Interventions: Coordinated home visit and office intervention, office intervention, and usual care. Home visits by 3 public health nurses provided parental education and social support and linked families with needed community resources. Women in the office intervention group were encouraged to seek health care for their infants from one of the primary care practices. Participating offices received assistance with Medicaid billing, help developing a system to improve preventive care, and customized patient education materials. Results: Mothers reported that the nurses helped them in areas related to the content of the program. An office system for prevention was developed and implemented in all 4 practices for study patients. Families in the intervention groups were more likely than control families to have had a prenatal visit with a pediatrician (P=.01, χ2), a primary care office as the regular source of sick care (P=.02, χ2), and less waiting time (P=.02, Student t test). They were also more likely to recall receiving patient education materials (P=.007, χ2). Conclusions: It is feasible to link clinical and public health approaches to improve the quality and effectiveness of care for socially disadvantaged children. Such interventions should be tested in defined populations.Arch Pediatr Adolesc Med. 1996;150:815-821 References 1. Adler N, Boyce W, Chesney M, Folkman S, Syme L. Socioeconomic inequalities in health: no easy solution . JAMA . 1993;269:3140-3145.Crossref 2. Ramey CT, Bryant DM, Wasik BH, Sparling JJ, Fendt KH, LaVange LM. Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence . Pediatrics . 1992;89:454-465. 3. Institute of Medicine; Millman M, ed. Access to Health Care in America . Washington, DC: National Academy Press; 1993. 4. Margolis P, Cook R, Earp JA, Lannon C, Keyes L, Klein J. Factors associated with pediatricians' participation in Medicaid in North Carolina . JAMA . 1992; 267:1942-1946.Crossref 5. Kottke T, Brekke M, Solberg L. Making 'time' for preventive services . Mayo Clin Proc . 1993;68:785-791.Crossref 6. Szilagyi PG, Rodewald LE, Humiston SG, et al. Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status . Pediatrics . 1993;91:1-7. 7. Erratum : Pediatrics . 1993:91:5451. 8. Academy of Pediatrics Ad Hoc Task Force on the Definition of the Medical Home. The medical home . Pediatrics . 1992:90:774. 9. Green M, Kessel S. Diagnosing and treating health: bright futures . Pediatrics . 1993;91:998-1000. 10. Baker E, Melton R, Strange P, et al. Health reform and the health of the public: forging community health partnerships . JAMA . 1994;272:1276-1282.Crossref 11. Margolis P, Carey T, Lannon C, Earp J, Leininger L. The rest of the access-to-care puzzle: addressing structural and personal barriers to health care for socially disadvantaged children . Arch Pediatr Adolesc Med . 1995;149:541-545.Crossref 12. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation . Pediatrics . 1986;77:16-28. 13. Erratum : Pediatrics . 1986;78:1381. 14. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation . Am J Public Health . 1988;78:1436-1445.Crossref 15. Lannon C, Brack V, Stuart J, et al. What mothers say about why poor children fall behind on immunizations: a summary of focus groups in North Carolina . Arch Pediatr Adolesc Med . 1995;149:1070-1075.Crossref 16. Kottke T, Solberg L, Brekke M, Maxwell P. Smoking cessation strategies and evaluation . J Am Coll Cardiol . 1988;12:1105-1110.Crossref 17. Olds D, Kitzman H, Cole R. Effect of home visitation by nurses on caregiving and maternal life-course . Arch Pediatr Adolesc Med . 1995;149( (suppl) ):76. Abstract. 18. Dams P, Hardy A. Current estimates from the National Health Interview Survey: United States, 1988 . Vital Health Stat 10 . 1989;No. (173) . 19. Olds DL, Henderson CRJ, Phelps C, Kitzman H, Hanks C. Effect of prenatal and infancy nurse home visitation on government spending . Med Care . 1993; 31:155-174.Crossref 20. Halfon N, Berkowitz G, Klee L. Development of an integrated case management program for vulnerable children . Child Welfare . 1993;72:379-395. 21. Urbano M, vonWindeguth B, Siderits P, Parker J, Studenic-Lewis C. Developing case managers for chronically ill children: Florida's registered nurse specialist program . J Continuing Educ Nurs . 1991;22:62-66. 22. Davis B, Steele S. Case management for young children with special health care needs . Pediatr Nurs . 1991;17:15-19. 23. Olds DL, Kitzman H. Can home visitation improve the health of women and children at environmental risk? Pediatrics . 1990;86:108-116. 24. Dietrich AJ, Marton KI. Does continuous care from a physician make a difference? J Fam Pract . 1982;15:929-937. 25. Alpert J, Robertson L, Kosa J, Heagarty M, Haggerty R. Delivery of health care for children: report of an experiment . Pediatrics . 1976;57:917-930. 26. Spivak H, Levy J, Bonanno R, Cracknell M. Patient and provider factors associated with selected measures of quality of care . Pediatrics . 1980;65:307-313. 27. Charney E, Bynum R, Eldredge D, et al. How well do patients take oral penicillin? Pediatrics . 1967;40:188-195. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Linking Clinical and Public Health Approaches to Improve Access to Health Care for Socially Disadvantaged Mothers and Children: A Feasibility Study

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1996.02170330041007
Publisher site
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Abstract

Abstract Objective: To test the feasibility of combining home-and office-based interventions to improve access to health care and health outcomes of Medicaid-eligible mothers and infants. Design: Randomized trial in 2 counties in North Carolina (1 rural, 1 urban). Information on health and developmental outcomes was obtained by face-to-face interviews, medical chart abstractions, hospital medical records, and state data tapes. Participants: Ninety-three Medicaid-eligible first-time pregnant women in their third trimester and their subsequently born infants, who were followed up until they were 6 months old, and 3 pediatric practices and 1 family practice. Interventions: Coordinated home visit and office intervention, office intervention, and usual care. Home visits by 3 public health nurses provided parental education and social support and linked families with needed community resources. Women in the office intervention group were encouraged to seek health care for their infants from one of the primary care practices. Participating offices received assistance with Medicaid billing, help developing a system to improve preventive care, and customized patient education materials. Results: Mothers reported that the nurses helped them in areas related to the content of the program. An office system for prevention was developed and implemented in all 4 practices for study patients. Families in the intervention groups were more likely than control families to have had a prenatal visit with a pediatrician (P=.01, χ2), a primary care office as the regular source of sick care (P=.02, χ2), and less waiting time (P=.02, Student t test). They were also more likely to recall receiving patient education materials (P=.007, χ2). Conclusions: It is feasible to link clinical and public health approaches to improve the quality and effectiveness of care for socially disadvantaged children. Such interventions should be tested in defined populations.Arch Pediatr Adolesc Med. 1996;150:815-821 References 1. Adler N, Boyce W, Chesney M, Folkman S, Syme L. Socioeconomic inequalities in health: no easy solution . JAMA . 1993;269:3140-3145.Crossref 2. Ramey CT, Bryant DM, Wasik BH, Sparling JJ, Fendt KH, LaVange LM. Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence . Pediatrics . 1992;89:454-465. 3. Institute of Medicine; Millman M, ed. Access to Health Care in America . Washington, DC: National Academy Press; 1993. 4. Margolis P, Cook R, Earp JA, Lannon C, Keyes L, Klein J. Factors associated with pediatricians' participation in Medicaid in North Carolina . JAMA . 1992; 267:1942-1946.Crossref 5. Kottke T, Brekke M, Solberg L. Making 'time' for preventive services . Mayo Clin Proc . 1993;68:785-791.Crossref 6. Szilagyi PG, Rodewald LE, Humiston SG, et al. Missed opportunities for childhood vaccinations in office practices and the effect on vaccination status . Pediatrics . 1993;91:1-7. 7. Erratum : Pediatrics . 1993:91:5451. 8. Academy of Pediatrics Ad Hoc Task Force on the Definition of the Medical Home. The medical home . Pediatrics . 1992:90:774. 9. Green M, Kessel S. Diagnosing and treating health: bright futures . Pediatrics . 1993;91:998-1000. 10. Baker E, Melton R, Strange P, et al. Health reform and the health of the public: forging community health partnerships . JAMA . 1994;272:1276-1282.Crossref 11. Margolis P, Carey T, Lannon C, Earp J, Leininger L. The rest of the access-to-care puzzle: addressing structural and personal barriers to health care for socially disadvantaged children . Arch Pediatr Adolesc Med . 1995;149:541-545.Crossref 12. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation . Pediatrics . 1986;77:16-28. 13. Erratum : Pediatrics . 1986;78:1381. 14. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation . Am J Public Health . 1988;78:1436-1445.Crossref 15. Lannon C, Brack V, Stuart J, et al. What mothers say about why poor children fall behind on immunizations: a summary of focus groups in North Carolina . Arch Pediatr Adolesc Med . 1995;149:1070-1075.Crossref 16. Kottke T, Solberg L, Brekke M, Maxwell P. Smoking cessation strategies and evaluation . J Am Coll Cardiol . 1988;12:1105-1110.Crossref 17. Olds D, Kitzman H, Cole R. Effect of home visitation by nurses on caregiving and maternal life-course . Arch Pediatr Adolesc Med . 1995;149( (suppl) ):76. Abstract. 18. Dams P, Hardy A. Current estimates from the National Health Interview Survey: United States, 1988 . Vital Health Stat 10 . 1989;No. (173) . 19. Olds DL, Henderson CRJ, Phelps C, Kitzman H, Hanks C. Effect of prenatal and infancy nurse home visitation on government spending . Med Care . 1993; 31:155-174.Crossref 20. Halfon N, Berkowitz G, Klee L. Development of an integrated case management program for vulnerable children . Child Welfare . 1993;72:379-395. 21. Urbano M, vonWindeguth B, Siderits P, Parker J, Studenic-Lewis C. Developing case managers for chronically ill children: Florida's registered nurse specialist program . J Continuing Educ Nurs . 1991;22:62-66. 22. Davis B, Steele S. Case management for young children with special health care needs . Pediatr Nurs . 1991;17:15-19. 23. Olds DL, Kitzman H. Can home visitation improve the health of women and children at environmental risk? Pediatrics . 1990;86:108-116. 24. Dietrich AJ, Marton KI. Does continuous care from a physician make a difference? J Fam Pract . 1982;15:929-937. 25. Alpert J, Robertson L, Kosa J, Heagarty M, Haggerty R. Delivery of health care for children: report of an experiment . Pediatrics . 1976;57:917-930. 26. Spivak H, Levy J, Bonanno R, Cracknell M. Patient and provider factors associated with selected measures of quality of care . Pediatrics . 1980;65:307-313. 27. Charney E, Bynum R, Eldredge D, et al. How well do patients take oral penicillin? Pediatrics . 1967;40:188-195.

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Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Aug 1, 1996

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