Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, STATE, Policy/Guideline (State), Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Intervention Results: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Conclusion: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Study Design: Time trend analysis

Setting: All Arkansas hospitals Five level III hospitals from 2001- 2005, six in 2006

Population of Focus: Infants born at <35 weeks GA

Data Source: Data from Medicaid claims for pregnancy linked to birth certificates for women covered by Medicaid in Arkansas

Sample Size: Total (n= 5,150) 2001 (n= 812) 2002 (n= 1,105) 2003 (n= 824) 2004 (n= 824) 2005 (n= 887) 2006 (n= 698) Infants born at <35 weeks GA

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, STATE, Policy/Guideline (State)

Intervention Description: In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001–December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

Intervention Results: Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.

Conclusion: Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.

Setting: Hospitals in Arkansas

Population of Focus: Medicaid-covered women in Arkansas

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Consultation (Parent/Family), Access to Provider through Hotline, PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines.

Intervention Results: A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Conclusion: Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Enabling Services, Access to Provider through Hotline

Intervention Description: To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol in addition to the usual care for smoking cessation for pregnant women to demonstrate the feasibility of recruitment, randomization, assessment, and implementation of the PPCC intervention.

Intervention Results: PPCC was found to be feasible and acceptable to some participants but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 days vs 55 days, for Control and Experimental groups respectively).

Conclusion: The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.

Study Design: RCT pilot

Setting: Obstetrics clinic

Population of Focus: Low-income pregnant women attending their first prenatal visit at a single academic obstetrics clinic

Data Source: Urine testing, Surveys

Sample Size: 130

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital), STATE, Policy/Guideline (State)

Intervention Description: Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.

Intervention Results: Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion: Telemedicine is an effective way to translate evidence based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.

Study Design: Time trend analysis

Setting: All Arkansas hospitals

Population of Focus: Infants born weighing 500-2499 gm. Data not given for other study years.

Data Source: Data from Arkansas Vital Statistics Data System linked with corresponding hospitalization records from Arkansas Hospital Discharge Data System.

Sample Size: Total (n= 12,258) 2001 (n= 2,965) 2004 (n= 3,154)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Access to Provider through Hotline, Consultation (Parent/Family), PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.

Intervention Results: During the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]).

Conclusion: Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Access to Provider through Hotline

Intervention Description: We tested the efficacy of a minimal intervention to create smoke-free homes in low-income households recruited through the United Way of Greater Atlanta 2-1-1, an information and referral system that connects callers to local social services.

Intervention Results: Participants were mostly smokers (79.7%), women (82.7%), African American (83.3%), and not employed (76.5%), with an annual household income of $10 000 or less (55.6%). At 6-months postbaseline, significantly more intervention participants reported a full ban on smoking in the home than did control participants (40.0% vs 25.4%; P = .002). The intervention worked for smokers and nonsmokers, as well as those with or without children.

Conclusion: Minimal intervention was effective in promoting smoke-free homes in low income households and offers a potentially scalable model for protecting children and adult nonsmokers from secondhand smoke exposure in their homes.

Study Design: RCT

Setting: Community (2-1-1 Information and Referral System)

Population of Focus: Families with smoke-free homes in low-income households

Data Source: 2-1-1 line agents and interview data

Sample Size: 498 randomized into Intervention (246) and Control (252)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, School-Based Family Intervention, Access to Provider through Hotline,

Intervention Description: To identify whether there were differential patterns of children's school attendance and stability, we employed a repeated measures latent class analysis (RMLCA; Collins & Lanza, 2009). Latent class analysis is a person-centered technique that is used to identify mutually exclusive and exhaustive subgroups of participants within the population of interest based on similar patterns of responses to indicator variables (i.e., similar experiences with school attendance and stability).

Intervention Results: The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement.

Conclusion: Preventing homelessness, especially for families, will take coordination across disciplines and systems, including addressing the cost of housing, extreme poverty, educational disparities, and lack of support for mental health and drug abuse, to name only a few of the complicated issues that contribute to homelessness across the country.

Study Design: person-centered analytic technique

Setting: Massachusetts

Population of Focus: Teachers, public health professionals

Sample Size: N/A

Age Range: Kindergarten through 3rd grade (5-9 yr olds)