Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, STATE, Policy/Guideline (State), Funding Support, Perinatal Committees/Councils

Intervention Description: Vital records data (1971 to 1978) were used to assess the change in neonatal and fetal mortality in Colorado in relationship to the regionalization of perinatal health care within the state.

Intervention Results: There has been a decrease in neonatal mortality rate from 13.4 to 6.9 during a period of time when there was a minimal decrease in the incidence of low-birth weight infants. The improved neonatal mortality has been associated with a shift in the frequency of birth of very low-birth weight (VLBW) infants to hospitals with level II and III perinatal services and relatively greater survival rates of VLBW infants born in these hospitals as compared to those born in level I hospitals. There was no decrease in fetal mortality in the same period of time.

Conclusion: These date suggest that outreach education in perinatal medicine should now emphasize current knowledge and methods for reducing antepartum deaths.

Study Design: QE: pretest-posttest

Setting: All Colorado hospitals Three level III, seven level II, remaining level I

Population of Focus: Infants born weighing greater than one lb.

Data Source: Data from the Bureau of Vital Records, Colorado State Health Department.

Sample Size: Pretest: 1.8% (n=2,818) Posttest: 1.8% (n=2,967) Infants born weighing one to four lbs.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Description: A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification.

Intervention Results: Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Conclusion: Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 129 level I, 11 level II, and one level III hospital Posttest: 118 level I, 11 level II, and one level III hospital

Population of Focus: All infants born at ≥20 weeks GA and ≤1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 432) Posttest (n= 343)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Funding Support,

Intervention Description: The intervention involved the introduction of funded influenza vaccines for children younger than 5 years in 2018, implemented at the state/territory level.

Intervention Results: The study replicated earlier findings of increased vaccination in children aged 6 months to less than 5 years in 2018, specifically in jurisdictions that introduced funded vaccination for this age group. The results also indicated a flow-on increase in vaccinations for older children and potentially for adults living with vaccinated children.

Conclusion: The study concluded that funding vaccines for young children is an effective tool for increasing community vaccination coverage. It also highlighted the potential flow-on effect of increased vaccination rates in older children and adults residing with vaccinated children.

Study Design: The study employed an observational design, utilizing data from general practitioner surveillance and alternative data sources to evaluate the impact of state/territory funding initiatives on influenza vaccine uptake.

Setting: The setting of the study is Australia, focusing on the impact of state/territory funding initiatives on influenza vaccine uptake in children.

Population of Focus: The target audience includes children aged 6 months to less than 5 years, as well as older children (5-17 years) and adults residing with vaccinated children.

Sample Size: The study does not explicitly mention the specific sample size. However, it is indicated that the analysis involved a national study using general practitioner surveillance and alternative data sources

Age Range: The age range of the target population includes children aged 6 months to less than 5 years, older children (5-17 years), and adults residing with vaccinated children.

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent Approach, Funding Support, Community Health Workers (CHWs),

Intervention Description: This multi-component intervention included patient education about health conditions (hypertension, gestational diabetes, and depression), important health behaviors (nutrition and exercise), and common postpartum symptoms; taught self-management skills; enhanced social support; and connected patients with community resources and health care services, including transportation needs. The intervention also addressed specific psychosocial needs of enrollees. A payment reform component included a cost-sharing arrangement between the health care system and the Medicaid payer to cover costs related to employing a social worker and community health worker, and financial incentives for completed postpartum visits.

Intervention Results: Compared with women in the control group, program participants had higher rates of postpartum visits in the HEDIS-defined time period (66.9% vs 56.0%; P < .001) and higher rates of all postpartum outpatient or gynecologic care up to 90 days after delivery (90.2% vs 83.4%; P= .002). Similarly, program participants were more likely to be enrolled with the Medicaid plan than mothers in the matched comparison group at six months after delivery (79.1% [400/506] vs 73.3% [742/1012]; P= .015) and at one year after delivery (71.0% [359/506] vs 66.3% [671/1012]; P= .067), although this was not statistically significant at one year after delivery.

Conclusion: This novel partnership between a health care system and a Medicaid payer increased postpartum visits among high-risk, low-income mothers. The follow-up rate was higher for visits that occurred within 90 days after delivery, a period consistent with current recommendations for postpartum care from the American College of Obstetricians and Gynecologists. This is one of few initiatives that have integrated health care systems, payers, physicians, and social workers to address access to care and social determinants of health for underserved women.

Study Design: Propensity scoring of Medicaid claims data from 2014 to 2017 was used to compare timely postpartum visits for mothers enrolled in the intervention program versus a similar group of mothers enrolled in the same Medicaid plan who gave birth in 2015 and 2016.

Setting: Mount Sinai Hospital, a large tertiary hospital in New York City

Population of Focus: Women insured by Healthfirst who delivered between April 2015 and October 16 who spoke Spanish or English and had at least 1 of the following: gestational diabetes, hypertension, positive screen for depression, late registration for prenatal care (> 20 weeks), or residence in neighborhoods considered at high risk for diabetes or hypertension.

Sample Size: 506

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), STATE, Policy/Guideline (State), Funding Support

Intervention Description: This report summarizes the evaluation of a national demonstration program of such regionalization that was funded by the Robert Wood Johnson Foundation (RWJF) in 1975.

Intervention Results: In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected.

Conclusion: Surveys of surviving 1-year-old infants showed that the decrease in neonatal mortality was accompanied by a decrease in selected morbidity.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Eight regions and eight comparison regions

Population of Focus: Infants born weighing ≤1500

Data Source: Data from reproduced computer tapes of births and matched infant death and birth certificates obtained from state and local health offices in several states.

Sample Size: Intervention group: Pretest (n≈ 4080) Intervention (n≈ 3416) Posttest: (n≈ 4033) Comparison: Pretest: (n≈ 5221) Intervention: (n≈ 4297) Posttest: (n≈ 4596)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State), Funding Support, POPULATION-BASED SYSTEMS, PATIENT/CONSUMER, Educational Material

Intervention Description: The goal of this study was to examine state measurements and improvements in risk-appropriate care for very low birth weight (VLBW) infants.

Intervention Results: Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care.

Conclusion: Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.