Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html

July 9, 2010

1. ANALYSIS OF HEALTH REFORM FOCUSES ON OPPORTUNITIES AND CHALLENGES FOR STATE MCH PROGRAMS

Implementing Health Reform: Key Provisions and Opportunities for Title V MCH Programs outlines a discussion from the Association of Maternal and Child Health Program (AMCHP) Board of Directors Meeting, held on June 26, 2010, in Washington, DC. The content of the document is based on feedback gathered by AMCHP regional directors from state maternal and child health (MCH) program directors, state children with special health care needs program directors, and other state delegates throughout April and May 2010. Topics include MCH provisions in health reform, AMCHP's implementation plan and perspective, immediate and long-term opportunities, and challenges. Opportunities and challenges for state MCH programs are addressed in the areas of insurance coverage expansion, benefits package and insurance reform, health system improvements, and public health and prevention investments. Information about state roles and key dates, as well as additional resources, are provided. The document is available at
http://www.amchp.org/Advocacy/health-reform/Documents/Implementing%20Health%20Reform%20Key%20Opportunities%20and%20Provisions%20for%20Title%20V%20MCH%20Programs.pdf

• Well-represented pediatric diseases were those characterized by high prevalence (asthma, type 1 diabetes), acute need caused by geographical barriers or other lack of health professional access (psychiatric disorders, cardiac disorder, burns), or those requiring continuity of care in home or community settings (type 1 diabetes, special health care needs, cancer, complex heath care needs post-discharge).
• Efforts to estimate the value of HIT interventions included measurement of child- or caregiver-important outcomes such as quality of life (21 studies, 20 percent) or clinical outcomes (33 studies, 32 percent) and evaluations of resource use that often comprise some degree of economic analysis (26 studies, 25 percent).
• Few studies were capable of providing definitive evidence: 16 percent were random controlled trials, while only 11 percent qualified as evaluation studies.

• Both intervention and control schools had reductions in the prevalence of overweight and obesity, with no significant difference between the groups. However, there was a nearly significant reduction in the prevalence of obesity in the intervention schools, compared with the control schools; students in the intervention schools had 19 percent lower odds of being obese at the end of the study than did those in the control schools.
• The BMI z scores and the percentage of students with waist circumference in the 90th percentile or higher at the end of the study were significantly lower in the intervention schools than in the control schools.
• Among the 2,292 students who were overweight or obese in sixth grade (approximately 50 percent of the sample), there were significant and nearly identical decreases in the prevalence of overweight and obesity in the intervention and control schools (15.9 percent control, 16.5 percent intervention).
• Students in intervention schools who were overweight or obese in sixth grade had 20 percent lower odds of being obese at the end of eighth grade, compared to those in control schools. In addition, intervention schools had a significantly lower percentage of students with waist circumference at or above the 90th percentile at the end of the study.
• Among students who were overweight or obese in sixth grade, there was a trend toward greater reductions in BMI z scores in the intervention schools than in the control schools.