Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Continuity of Care (Caseload), Midwifery, Home Visit (caregiver),

Intervention Description: A model pilot program was established in South Australia to address the ongoing closure of regional maternity services and bring sustainable birthing services to the area with the aim of keeping birthing as close to home as safely possible. This Midwifery Caseload Model of Care (MMoC) model was an all-risk model or care whereby 12.9 full-time equivalent midwives were employed to work in collaboration with general practitioners (GP)/obstetricians across five birthing sites (Port Pirie, Crystal Brook, Wallaroo, Clare and Jamestown). In the MMoC all pregnant women in the region could be referred to the program and allocated to a known midwife once pregnancy had been confirmed. Care was then provided by the MMoC midwife and an obstetric GP or obstetrician. The service delivery model prioritized choice and interdisciplinary care. An anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period.

Intervention Results: Most women (97%) received a postnatal visit from a MMoC midwife and 84.1% reported the MMoC midwives were their main postpartum care provider. Shared care GP/MMoC midwives accounted for 8.9% (n = 17) and 6.9% (n = 13) indicated they had “other” postnatal care such as child and family health nurse, midwives and nurses at the birth hospital, and midwives at referral hospital due to baby’s prematurity. Overall women had an average of four postnatal visits. Close to a third of women (32.5%) had six or more visits. Most women (77%) reported receiving their visit in their home or a combination of home and not at home (20%). Only 3.2% of visits were not conducted at home. In addition to midwifery visits, most women (approximately 80%) also used community supports, the most frequently being child and family health nurses.

Conclusion: In this regional/rural MMoC, women were able to receive quality continuity and components of care as have been previously benchmarked against the QMNC Framework. Women embraced the new MMoC, established strong relationships with their midwives and were able to maintain good collaborative arrangements with their local GPs. The generalisability of these results should be considered for other regions which offer maternity services and have GP obstetrician support. These findings are consistent with existing evidence that supports midwifery continuity of care for women and adds to the growing body of evidence for midwifery caseload outside of metropolitan areas

Study Design: Mixed methods design using qualitative and quantitative methodologies

Setting: Five birthing sites in South Australia (Port Pirie, Crystal Brook, Wallaroo, Clare and Jamestown).

Population of Focus: Pregnant women in regional/rural areas

Sample Size: 205

Age Range: 16-42 years

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Access,

Intervention Description: Family Connects is a short-term nurse home visiting approach designed to deliver brief education and intervention, assess family needs, and connect families to community resources for ongoing support. Impact evaluation compared outcomes for families of infants born in the months immediately prior to program launch (comparison group n = 360; Feb. 1, 2014–July 31, 2014) to families of infants born during the FC implementation period (intervention group n = 1068; Sept. 1, 2014-Dec. 31, 2015). Outcomes were assessed for both groups via a 30-min telephone interview when the infants were 6 months old.

Intervention Results: No group differences were found in total emergency care utilization for birthing parents (see Table 3). FC parents reported making more ED and urgent care visits for themselves than did comparison group parents (95% CI = 0.04, 0.51; effect size = 0.14) and (non-significantly) fewer hospital overnight stays. FC parents reported greater perceived social support relative to comparison group parents (95% CI = 0.01, 0.14; effect size = 0.13). No differences were observed for maternal 6-week postpartum health-check completion or endorsed symptoms of depression or anxiety.

Conclusion: Results from this quasi-experimental field trial indicate that FC effectively engages families living in high-poverty rural counties during the postpartum period with broad reach and high program fidelity, leading to positive population impacts on family health and well-being. Implementation findings indicate FC had broad community reach, high nurse reliability and fidelity to the manualized protocol, and nurse-family referral connection rates that exceeded rates observed in prior trials (Dodge et al., 2014, 2019). The findings provide compelling evidence that FC can be disseminated through rural public health departments with high quality. The high completion rate (65% of all eligible families) suggests that the FC is well suited for rural contexts.

Study Design: Quasi-experimental design

Setting: Four rural Eastern North Carolina counties

Population of Focus: Families living in high-povery rural counties

Sample Size: 392 intervention group families and 126 families with infants born between Feb. 1, 2014–July 31, 2014 (natural comparison group).

Age Range: Reproductive age (≥Teenage)

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Access, Patient Navigation,

Intervention Description: The implementation of clinical-community linkages to engage Medicaid-insured pregnant women in underutilized home visiting services for enhanced prenatal care coordination.

Intervention Results: Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting. When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1–10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4–14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3–5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3–14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed.

Conclusion: Clinical–community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical–community linkages

Study Design: Quasi-experimental design

Setting: A Federally Qualified Health Center (FQHC) and a hospital-based obstetrics and gynecology residency practice

Population of Focus: Medicaid-insured pregnant women; healthcare pracitioners

Sample Size: 1,017 (Combined FQHC and Ob/Gyn residency practice)

Age Range: n/a