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Meghea, C. I., You, Z., & Roman, L. A. (2015). A statewide Medicaid enhanced prenatal and postnatal care program and infant injuries. Maternal and Child Health Journal, 19(10), 2119–2127.

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 None None
Notes:

In 2020, HomVEE updated this review to move 18 findings related to child injuries and ingestions that were mistakenly placed in the Child Health domain to the Reductions in Child Maltreatment domain where HomVEE typically categorizes such findings.

Study characteristics
Study participants The study population included 27,320 women (13,660 women each in the treatment and comparison groups) who were recipients of Medicaid, delivered a baby during the 2011 calendar year in Michigan, and for whom the baby survived his or her first year after birth. The study sample was, on average, 25 years old. Slightly less than 27 percent of the women were married. About 57 percent of women in the research sample were white, 37 percent were black, 5 percent were a different race or ethnicity, and less than 1 percent were American Indian. Just more than one-quarter of women in the research sample were living at or below 33 percent of the federal poverty level, and about two-thirds were receiving Medicaid before their pregnancy.
Setting The study took place across 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 People in the comparison condition received Medicaid during the study period but did not participate in any MIHP services.
Staff characteristics and training The study did not provide information on staff characteristics or training.
Funding sources The study was partly supported through a grant from the Michigan Department of Community Health.
Author affiliation None of the study authors are developers of this model. The authors explicitly reported no conflict of interest.
Study Registration:

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

Findings details

Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Burns
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomeVEE calculated = 0.11 Not statistically significant, p = 0.16

Program and comparison group proportions are less than 0.010. Group differences are very small.

Moderate Crush injury
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.81

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Dislocations and strains and sprains
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomeVEE calculated = 0.08 Not statistically significant, p = 0.62

Program and comparison group proportions are less than 0.010. Group differences are very small.

Moderate Foreign body
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.01 MD = 0.00 HomeVEE calculated = 0.21 Statistically significant, p = 0.01

Group differences are very small.

Moderate Fracture lower limb
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.33

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Fracture neck and trunk
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.42 Not statistically significant, p = 0.48

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Fracture skull that apart from vault or base
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.51

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Fracture skull vault or base
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.68

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Fracture upper limb
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = -0.17 Not statistically significant, p = 0.32

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Internal trauma
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.56

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Intracranial Injury
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.01 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.25 Statistically significant, p = 0.04

Program and comparison group proportions are less than 0.010. Group differences are very small.

Moderate Multiple fractures of limbs
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.56

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Nerve and spinal cord
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p = 0.81

Program and comparison group proportions are less than 0.005. Group differences are very small.

Moderate Open wounds
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.02 Unadjusted proportion = 0.01 MD = 0.00 HomeVEE calculated = 0.17 Statistically significant, p = 0.02

Group differences are very small.

Moderate Poisoning
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.02 Unadjusted proportion = 0.02 MD = 0.00 HomeVEE calculated = -0.07 Not statistically significant, p = 0.33

Group differences are very small.

Moderate Proportion of infants with at least one injury episode
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.12 Unadjusted proportion = 0.10 MD = 0.01 HomeVEE calculated = 0.08 Statistically significant, p = 0.00
Moderate Superficial injuries and contusion
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.05 Unadjusted proportion = 0.04 MD = 0.01 HomeVEE calculated = 0.14 Statistically significant, p = 0.01
Moderate Vascular injury
FavorableUnfavorable or ambiguousNo Effect
Full sample; Michigan Medicaid 2011 birth cohort 12 months postpartum 27,320 infants Unadjusted proportion = 0.00 Unadjusted proportion = 0.00 MD = 0.00 HomeVEE calculated = -0.42 Not statistically significant, p = 0.48

Program and comparison group proportions are less than 0.005. Group differences are very small.

Outcome measure summary

Reductions in child maltreatment
Outcome measure Description of measure Data collection method Properties of measure

Burns

Primary diagnosis recorded in Medicaid claims: burns

Medicaid records

Not applicable

Crush injury

Primary diagnosis recorded in Medicaid claims: crush injury

Medicaid records

Not applicable

Dislocations and strains and sprains

Primary diagnosis recorded in Medicaid claims: dislocation and strains and sprains

Medicaid records

Not applicable

Foreign body

Primary diagnosis recorded in Medicaid claims: foreign body

Medicaid records

Not applicable

Fracture lower limb

Primary diagnosis recorded in Medicaid claims: fracture lower limb

Medicaid records

Not applicable

Fracture neck and trunk

Primary diagnosis recorded in Medicaid claims: fracture neck and trunk

Medicaid records

Not applicable

Fracture skull that apart from vault or base

Primary diagnosis recorded in Medicaid claims: fracture skull that apart from vault or base

Medicaid records

Not applicable

Fracture skull vault or base

Primary diagnosis recorded in Medicaid claims: fracture skull vault or base

Medicaid records

Not applicable

Fracture upper limb

Primary diagnosis recorded in Medicaid claims: fracture upper limb

Medicaid records

Not applicable

Internal trauma

Primary diagnosis recorded in Medicaid claims: internal trauma

Medicaid records

Not applicable

Intracranial Injury

Primary diagnosis recorded in Medicaid claims: intracranial injury

Medicaid records

Not applicable

Multiple fractures of limbs

Primary diagnosis recorded in Medicaid claims: multiple fractures of limbs

Medicaid records

Not applicable

Nerve and spinal cord

Primary diagnosis recorded in Medicaid claims: nerve and spinal cord

Medicaid records

Not applicable

Open wounds

Primary diagnosis recorded in Medicaid claims: open wounds

Medicaid records

Not applicable

Poisoning

Primary diagnosis recorded in Medicaid claims: poisoning

Medicaid records

Not applicable

Proportion of infants with at least one injury episode

Primary diagnosis recorded in Medicaid claims: at least one injury

Medicaid records

Not applicable

Superficial injuries and contusion

Primary diagnosis recorded in Medicaid claims: superficial injuries and contusion

Medicaid records

Not applicable

Vascular injury

Primary diagnosis recorded in Medicaid claims: vascular injury

Medicaid records

Not applicable