12 th MCH EPI Conference

1. 12th MCH EPI Conference Chinelo A. Ogbuanu, MPH, MBBS Doctoral Student Dept. of Health Services Policy and Management Arnold School of Public Health University of South Carolina

2. Evaluation of the Postpartum/Newborn Home Visit Service:Aiken County, Health Region 5, SCDHEC • Chinelo A. Ogbuanu, MBBS, MPH • Candace A. Jones, MPH, RD • James F. McTigue, PhD • Samuel L. Baker, PhD • Marge Heim, MS, APRN, BC • JongDeuk Baek, PhD • Lillian U. Smith, DrPH, MPH, CHES

3. Overview of Presentation Background Study Questions Methods Results/Limitations Conclusions Public Health Implications Acknowledgements

4. Overview of Home Visit Programs • Definition: • A service strategy • Involves an actual visit • General goals • Various programs which differ in: • Specific goals • Intensity of services • Staffing • Population served

5. Comparison of Different Programs

6. SC PPNBHV Service • Inception: Late 1980s • Target: Medicaid newborns/mothers • Assess needs & link dyad to preventive health services in order to reduce IMR • 1 – 2 visits per birth episode (Birth – 6 weeks) • Visits are made following referral from a primary care provider • Trained PHNs with pediatric experience

7. Effects of Home Visit Programs • Improvement economically in the lives of mothers (NFP) • Fewer subsequent pregnancies (NFP) • Increased intervals between births (NFP) • Cost savings ~ $182 (Hershey, PA) • Positive Effects on Breastfeeding • But: • No increases in the utilization of preventive health services • Home visits alone yield few proven effects

8. Study Questions • Is the home visit service being implemented as designed? • Is there a difference in outcomes between infants who receive a home visit and those who do not?

9. 1. Process Evaluation • To determine whether the service is being implemented as designed: • Timeliness (72 hrs after discharge) • Appropriate education/referral • Appropriate revisits

10. 2. Impact/Outcome Evaluation • To determine differences in the following outcomes b/w both groups of infants: • Age at enrollment in the WIC program • Medical provider status at 1 year • Immunization status at 6/9 months

11. Methods

12. Inclusion Criteria Aiken County, Health Region 5 All Active WIC Clients FY04 (1,467) Not born in FY04 (682) Born in FY04 (785) Random sample (184) Not selected (601) Records not available (8) Records available (176) Further Analysis

13. Methods • Data abstraction: • Manually • February 17 – March 16, 2006 • 23 variables (4 forms) • Analysis: • SAS 9.1 & Microsoft Excel

14. Results • Characteristics of study population • Results of Process Evaluation • Results of Impact/Outcome Evaluation • Limitations

15. Characteristics of Study Population • Gender: • Males: 89 (51%) • Females: 87 (49%) • Race: • White: 87 (49%) • Black: 76 (43%) • Hispanic: 12 (7%) • Asian: 1 (<1%)

16. Characteristics of Study Population • Birth weight: • LBW: 10 (6%) • NBW: 166 (94%) • WIC Mom Status: • Yes: 131 (74%) • No: 42 (24%) • Unknown: 3 (2%) • Home Visit Status: • Yes: 76 (43%) • No: 100 (57%)

17. Results : Process Evaluation • Timeliness of home visit • Efforts to address health problems • Revisits and their appropriateness

18. Home visit by age of infant

19. Home visit by number of days after discharge

20. Efforts made to Address Selected Health Problems

21. Revisits & Appropriateness • 6 infants (8%) had a revisit for appropriate reasons: • Primarily for weight re-check • Jaundice • Heart murmur

22. Results: Impact/Outcome Evaluation • Age at enrollment in the WIC program • Medical Provider Status at 1 year • Immunization status at 6 / 9 months

23. PPNBHV Infants Enroll Earlier

24. Age at Enrollment in WIC by Home Visit Status Home Visit Yes No

25. Age at enrollment (days) ≤ 21 > 21 76 Yes Home visit 100 No 176 114 62 Adj. OR= 4.0 (1.92 – 8.36)

26. Medical Provider Status • 110 infants - recertified at 1 year • 108 (98%) - medical provider for well care • No significant difference between both groups

27. Immunization Status at 6/9 months • Data available for 101 infants • 98 (97%) had up-to-date immunization • No significant difference found between both groups

28. Limitations • The infants were not randomized to the visit/no visit status • Program not implemented on planned schedule • Pilot study – caution in over-generalizing findings • Only WIC population: Selection bias • Incomplete data for certain variables

29. Conclusions • Less than 20% of infants received a timely home visit • Positive association between PPNBHV service and early enrollment in the WIC program • No significant difference was found in the utilization of preventive health services by both groups

30. Public Health Implications • Periodic program monitoring (county/state level) is necessary to ensure program fidelity, determine impact, and provide feedback for CQI • For a PPNBHV program, timeliness is key because the key physiologic events in the dyad occur in the third or fourth postpartum day • A home visit service of this nature is important as an entrée into other health care programs

31. SCDHEC: Central Office Harvey Kayman Sarah Fellows Burnese Walker Ann Lee Sarah Cooper SCDHEC: Aiken County Debbie Lotz Lisa Gibbons Ruthie Hewitt Medical Records Staff Acknowledgements