Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Access, Community Health Workers (CHWs), Mobile Programs

Intervention Description: The authors created extending Maternal Care After Pregnancy (eMCAP), a community-based program, to address health care disparities and enhance access to care for the 12 months after birth. The team also evaluated the ability of Z codes (ICD-10 codes for social determinants of health) to identify patients with health-related social needs. The program is a multidisciplinary effort of nurses, nurse home visitors, physicians, advanced practice providers (APRNs [advanced practice registered nurses]), community health workers (CHWs), social services, behavioral health teams, and pharmacists working within a specially designed electronic health registry linked to existing electronic medical records and an obstetric quality database.

Intervention Results: The eMCAP program demonstrated improvement in attendance and quality of postpartum care for women living in underserved areas with chronic hypertenion (CHTN) and diabetes mellitus (DM). Compared to matched controls who were provided standard referrals, follow-up postpartum attendance for eMCAP women with CHTN was significantly better at 2 weeks and 1, 3, 6, 9, and 12 months (all p < 0.001). Similarly, eMCAP women with DM had significantly better follow-up at 2 weeks (p = 0.04), 1 month (p = 0.002), and 3 months (p = 0.049), resulting in HbA1c values for DM being significantly lower (p < 0.05) throughout the postpartum period.

Conclusion: The postpartum period represents a critical opportunity to understand and improve short- and long-term health with various platforms suggested to combat this crisis, but the roles of access to care, community-based support, and electronic health management systems remain unknown. We offer our experiences from eMCAP as an opportunity for further study in other health care settings. The findings of improved health care outcomes are key measures important to improving maternal morbidity and mortality across the United States.

Study Design: Observational study

Setting: Parkland health system in Dallas

Population of Focus: Predominantly Black and Hispanic women

Sample Size: 1,479 enrolled women

Age Range: Reproductive age

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

Intervention Description: The Baby Love program, administered by the Social Work Division of the University of Rochester Strong Memorial Hospital, pairs licensed, master’s-prepared social workers with community health workers (CHWs) to address barriers to health for high-risk pregnant and parenting women and infants as part of an interdisciplinary, perinatal health care team. The program serves participants by (1) increasing linkage with health and community support services, (2) educating participants on perinatal- and parenting-related topics along with stress-reduction strategies, and (3) providing support and advocacy for participants. The CHW serves as the primary Baby Love service provider, completing regular home visits and forming supportive relationships throughout the course of a women’s pregnancy and for one year postpartum. To facilitate integrated care, all interventions are documented in the participant’s medical record.CHWs are trained based on the Family Development Credential Program, a strengths-based approach of partnership between the family and CHW that is focused on achieving identified service goals.

Intervention Results: During the study period, Baby Love participants had fewer adverse outcomes than did nonparticipants, including lower rates of preterm birth. Neonatal intensive care unit (NICU) admission rates were 16% among participants compared with 21% among nonparticipants. The odds of NICU admission, preterm birth, and low birth weight were all lower among Baby Love participants than nonparticipants, whereas the odds of attending a postpartum visit within 60 days and attending at least four well-child visits within six months after births were higher.

Conclusion: The societal imperative to improve perinatal outcomes continues to pose a public health challenge. Well-structured CHW-supported home-visiting programs are a promising tool to more fully address the needs of a broader population of diverse and socioeconomically disadvantaged pregnant women. The Baby Love program’s effectiveness at improving perinatal outcomes and addressing social determinants of health from its integrated placement within the health delivery system positions this program as a valuable contributor to a fully integrated care delivery system

Study Design: Retrospective cohort study

Setting: Social Work Division of the University of Rochester Strong Memorial Hospital

Population of Focus: At-risk pregnant women

Sample Size: 353 enrolled with Baby Love;102 in comparison group

Age Range: Childbearing age