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The impact of prenatal and postnatal home visiting on utilization of care.

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Call No.	RA645.36.N4 B73 2003
Author	Bracken, Ann Connolly.
Title	The impact of prenatal and postnatal home visiting on utilization of care.
Date	2003
Abstract	Research objective. Research suggests that home visiting services can have a significant impact on pregnancy outcomes, child health and development, parenting and maternal life course. The effect of home visiting on utilization of health services is not well understood. The purpose of this research is to study the impact of the New Hampshire Home Visiting Program on maternal and child utilization of care. Study design. Retrospective observational cohort design. The intervention group received home visiting services from a nurse and paraprofessional home visitor prenatally and in the first two years of life. Data sources included birth certificate data and Medicaid claims. Ninety-two home-visited mother/infant pairs enrolled in Medicaid were compared to a matched control group. Matching variables included Home-Visiting Service Area, teen birth, child age and marital status. Analysis was based on an intention to treat model. Multivariable regression models were developed to estimate the effect of home visiting on utilization. Principal findings. Home visited children had a higher proportion of observed per recommended well child visits (0.78 [0.74-0.82] vs. 0.60 [0.55-0.64], p < 0.001) and were more likely to be up-to-date with well child visits (84.8% vs. 52.2%, p < 0.001). There was no significant difference in use of acute or emergent care. Using logistic regression models, adjusting for teen birth, marital status, maternal education, maternal smoking, child's age, birthweight, plurality, use of prenatal care, acute care, emergent care, Medicaid enrollment, and Home Visiting Service Area, home visiting was a significant predictor of being up-to-date with well child visits and having at least 0.75 of observed per recommended well child visits. Conclusions. Many states and communities have invested in home visiting programs to improve the health and well-being of children and families. This study demonstrates that home visiting is associated with increased preventive care use in young children. Furthermore, this research demonstrates a methodology for use of existing state data sets to understand the impact of child health utilization after implementation of a state child health program. Further research with a larger sample may differentiate use of emergency department services and hospitalizations.
Description	v, 96 leaves : map 28 cm.
Format	application/pdf
Advisor	David C. Goodman.
Subject	Home care services -- Utilization -- New Hampshire. Home care services -- New Hampshire -- Evaluation. Maternal health services -- Utilization -- New Hampshire. Infant health services -- Utilization -- New Hampshire. Prenatal care -- Utilization -- New Hampshire. Postnatal care -- Utilization -- New Hampshire.
College	Dartmouth Medical School -- Center for the Evaluative Clinical Sciences.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.4

Title	Page 1
Format	application/pdf
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Full Text	The Impact of Prenatal and Postnatal Home Visiting on Utilization of Care Carol L. Folt. Ph.D. Dean of Graduate Studies A Thesis Submitted to the Faculty in partial fulfillment of the requirements for the degree of Doctor of Philosophy In Evaluative Clinical Sciences by Ann C. Bracken, M.D., M.S. DARTMOUTH COLLEGE Hanover, New Hampshire May 30, 2003 Examioing Committee: (QIair) ~id C. GoopllJ¥n. M.D.. M.S. c· " / William J. Kassler. M.D.. M.P.H. Lorraine V. Klerman. Dr.P.H.

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