Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing.
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing.
JAMA Pediatr. 2023 Sep 1;177(9):939-946. doi: 10.1001/jamapediatrics.2023.2310.
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.
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.
Participation in Strong Beginnings or usual care.
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).
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]).
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.
家庭访问被推荐用于解决母婴健康差距问题，但由于对出生结果的影响存在差异，因此使用不足。社区卫生工作者与护士和社会工作者合作开展的家庭访问可能是一种接触高风险人群、改善护理和结果以及解决不平等问题的策略。
评估与护士和社会工作者合作的社区卫生工作者提供的家庭访问方案（Strong Beginnings）对有医疗补助的分娩个体的不良出生结果和产妇护理的影响，与常规护理相比。
设计、地点和参与者：这是一项回顾性、基于人群的倾向评分匹配队列研究，使用了一个包括出生记录和医疗补助索赔的行政链接数据库，该数据库与方案参与情况相关联。Strong Beginnings 项目的暴露发生在密歇根州的一个县，该县包括密歇根州第二大都市区。研究参与者主要是非西班牙裔黑人和西班牙裔 Strong Beginnings 参与者，以及其他密歇根县（2016 年至 2019 年）有 Medicaid 保险出生的所有母婴对作为潜在的匹配非参与者。数据在 2021 年至 2023 年之间进行了分析。
参与 Strong Beginnings 或常规护理。
早产（出生时不到 37 周）、极早产（出生时不到 32 周）、低出生体重（出生时体重不足 2500 克）、极低出生体重（出生时体重不足 1500 克）、充足的产前护理和产后护理（出生后 3 周和 60 天）。
共纳入了 125252 个符合 Medicaid 资格的母婴对链接（平均年龄[SD]，26.6[5.6]岁；27.1%为非西班牙裔黑人）纳入分析样本（1086 例在 Strong Beginnings[平均年龄（SD），25.5（5.8）岁]；124166 例在常规产前护理中[平均年龄（SD），26.6（5.5）岁]）。在参与者中，SB 组的 1086 例中有 144 例（13.3%）和常规护理组的 124166 例中有 14984 例（12.1%）发生早产。与常规产前护理相比，参与 Strong Beginnings 计划与早产风险降低相关（-2.2%；95%CI，-4.1 至-0.3）、极早产风险降低（-1.2%；95%CI，-2.0 至-0.4）、极低出生体重风险降低（-0.8%；95%CI，-1.3 至-0.3）和更常见的充足产前护理（3.1%；95%CI，0.6-5.6），出生后第 3 周的产后护理（21%；95%CI，8.5-33.5）和出生后第 60 天的产后护理（23.8%；95%CI，9.7-37.9）。
与常规护理相比，与护士和社会工作者合作的社区卫生工作者提供的家庭访问方案与不良出生结果的风险降低、产前和产后护理的改善以及医疗补助分娩个体的差异减少相关。黑人个体的不良出生结果风险降低更大。
