Maternal Child Health Home Visiting in Montana: Effects on LBW and Premature Births and Medicaid Costs

Wednesday, 1 August 2012: 2:10 PM

Jo Ann Walsh Dotson, PhD, MSN, BSN
College of Nursing, Washington State University, Spokane, WA

Learning Objective 1: Examine the effect of home visiting on select birth outcomes, after controlling for adequacy of prenatal care.

Learning Objective 2: Compare the Medicaid costs for infants whose mothers did and did not receive home visiting services, after controlling for adequacy of prenatal care.

Purpose: The purpose of this study was to examine birth outcomes, specifically premature and low birth weight births in high risk women and Medicaid costs for infants born to high risk women in Montana, and to determine if home visiting effected those outcomes and costs. Home visiting has been and continues to be a method used to provide a wide variety of services to the maternal-child population in the US and in other countries.

Methods: The study was quasi-experimental, using a retrospective case control design. This type of design efficiently uses pre-existing public health data and allows for identification of and comparisons between an intervention (home visited) group and comparable high risk reference group, thereby enhancing sample size and power. Data sources included Montana birth certificates, Medicaid claims and public health home visiting (PHHV) program records.

Results: The research supported previous reports that demographic factors alone are not effective predictors of poor pregnancy outcomes. The present study did not find significant differences in the incidence of premature or low birth weight birth based on receipt of home visiting services; however, the low birth weight rate was lower in home visited clients. Home visiting services did not significantly affect Medicaid costs for infants born to women who received the services in the prenatal period.

Conclusion: Despite disparate findings in the literature regarding impacts on health outcomes, home visiting continues to be a popular service delivery model for maternal child health population in the U.S. Decisions to expand or modify home visiting must be based on sound research which can help improve the potential for positive outcomes for the clients. Birth certificate and Medicaid data, which includes valuable demographic, behavioral and medical content, can be valuable in field and population based public health research.