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Meghea, C. I., Raffo, J. E., Zhu, Q., & Roman, L. (2013). Medicaid home visitation and maternal and infant healthcare utilization. American Journal of Preventive Medicine, 45(4), 441–447.

Model(s) Reviewed: Maternal Infant Health Program (MIHP)
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Non-experimental comparison group design Not applicable Established on race/ethnicity and SES; outcome(s) not feasible to assess at baseline Not applicable None
Notes:
Study characteristics
Study participants The study population included women who were recipients of Medicaid and delivered a baby in Michigan in 2010. The authors obtained records from the state Medicaid program and the Michigan Department of Community Health to identify pregnant mothers who submitted a Medicaid claim identifying Maternal and Infant Health Program (MIHP) participation during pregnancy or an MIHP prenatal risk screening. These mothers were matched one-to-one with mothers in Medicaid claims data who did not participate in the MIHP program at pregnancy. Matching created groups similar on race, age, socio-economic status, marital status, and markers for maternal health. A total of 16,044 matched pairs of mothers were included in the analysis. Mothers were 26 years old, on average. One-third were married. About half were white, 39 percent were black, 7 percent were Hispanic, and 3 percent were another race. All mothers were eligible for Medicaid during pregnancy and 17 percent were living at or below 33 percent of the federal poverty level.
Setting The study took place throughout the state of Michigan.
Intervention services MIHP provides prenatal and postnatal home visiting to pregnant women and infants living in Michigan who are Medicaid beneficiaries. Participation is voluntary, and includes health risk screenings, care coordination, referrals to other services, and interventions that are tailored to the needs of each person. These interventions may address healthy pregnancies, positive birth outcomes, infant safety, and infant health and development.
Comparison conditions Mothers in the comparison condition did not volunteer to participate in MIHP services or receive an MIHP prenatal risk screening during pregnancy.
Staff characteristics and training The study did not provide information on staff characteristics or training.
Funding sources The study was funded in part by the Michigan Department of Community Health.
Author affiliation None of the study authors are developers of this model.
Study Registration:

Clinicaltrials.gov Identifier: None found. Study registration was assessed by HomVEE beginning with the 2014 review.

Findings details

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Adequate prenatal care
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2010 birth cohort 12 months postpartum 32,088 mothers Unadjusted proportion = 0.65 Unadjusted proportion = 0.63 OR = 1.06 HomeVEE calculated = 0.04 Statistically significant, p < 0.05

Effect size based on study OR

Submitted by barbara on Fri, 04/12/2019 - 18:55

HomVEE calculated the effect size based on the study-reported odds ratio.

Moderate Any prenatal care
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2010 birth cohort 12 months postpartum 32,088 mothers Unadjusted proportion = 0.99 Unadjusted proportion = 0.97 OR = 2.94 HomeVEE calculated = 0.65 Statistically significant, p < 0.05

Effect size based on study OR

Submitted by barbara on Fri, 04/12/2019 - 18:55

HomVEE calculated the effect size based on the study-reported odds ratio.

Moderate Appropriate postnatal visit
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2010 birth cohort 12 months postpartum 32,088 mothers Unadjusted proportion = 0.50 Unadjusted proportion = 0.41 OR = 1.50 HomeVEE calculated = 0.25 Statistically significant, p < 0.05

Effect size based on study OR

Submitted by barbara on Fri, 04/12/2019 - 18:55

HomVEE calculated the effect size based on the study-reported odds ratio.

Outcome measure summary

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Adequate prenatal care

Mother received adequate prenatal care as defined by the Adequacy of Prenatal Care Utilization (Kotelchuck) Index. Administrative records

Not applicable

Any prenatal care

Mother received any prenatal care. Administrative records

Not applicable

Appropriate postnatal visit

Mother had a postnatal visit between 21 and 56 days after delivery. Administrative records

Not applicable