Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all socio-economic status (SES) groups to screen.

Intervention Results: Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women.

Conclusion: Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.

Study Design: QE: pretest-posttest

Setting: Victoria

Population of Focus: Women with no history of hysterectomy

Data Source: Victorian Cervical Cytology Registry

Sample Size: Approximate total (N≈1,421,390)4

Age Range: 18-69

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy

Intervention Description: The aim of this pragmatic cluster quasi-randomised controlled trial was to assess the effectiveness of implementing the Baby-friendly Initiative (BFI) in community health services.

Intervention Results: Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months.

Conclusion: The Baby-friendly Initiative (BFI) in community health services increased rates of exclusive breastfeeding until 6 months.

Study Design: Pragmatic cluster quasi-experimental

Setting: 54 municipalities in six counties (Østfold,Vestfold, NordTrøndelag, Hordaland, Telemark, Finnmark)

Population of Focus: Mothers with infants ≥5 months old at the time of survey, who lived in the study area and had given birth to a singleton infant at ≥ 37 weeks GA with a birth weight ≥ 2000 gm

Data Source: Mother self-report

Sample Size: Intervention (n=1051/990)3 Control (n=981/916)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance.

Intervention Results: Among the newly insured group, utilization rates of preventive dental visits increased significantly from 0.24 to 0.63 encounters per patient per year between pretest and posttest (adjusted rate ratio=2.56, 95% CI: 2.38-2.75). Between-group pretest-posttest differences in rate ratios revealed that changes in utilization of preventive dental visits were significantly different from those of the continuously insured and continuously uninsured groups (p<0.001).

Conclusion: This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Community health centers (CHC) in Oregon

Population of Focus: Patients aged 2-18 years who were not pregnant and did not have insurance other than Medicaid/CHIP with ≥ 1 visit before and after their ‘start date’

Data Source: CHC EHR data; state administrative data

Sample Size: Newly insured (n=3,054) Continuously insured (n=10,946) Continuously uninsured (n=10,307)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada.

Intervention Results: No significant difference in the incidence of breastfeeding before and after the policy reform

Conclusion: For most indicators we find no effect.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: Children born between 1998- 2001 or 2000-2003 who were in two-parent families and did not live in Quebec

Data Source: Canadian Community Health Survey; Mother self-report

Sample Size: N/A4

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Notification/Information Materials (Online Resources, Information Guide), CLASSROOM, Adult-led Curricular Activities/Training, Enforcement of School Rules, SCHOOL, Assembly, Reporting & Response System, Bullying Committee, Teacher/Staff Meeting, Teacher/Staff Training, School Rules, Identification and Monitoring of/Increased Supervision in Targeted Areas, POPULATION-BASED SYSTEMS, COMMUNITY, Media Campaign (Print Materials, Radio, TV)

Intervention Description: To examine the effectiveness of a widely disseminated bullying prevention program.

Intervention Results: Regression analyses controlling for baseline prevalence and school characteristics showed no overall effect on student victimization. However, when stratified by ethnicity/race, reports of relational and physical victimization decreased by 28% (RR = .72, 95% CI: .53-.98) and 37% (RR = .63, 95% CI: .42-.97), respectively, among white students relative to those in comparison schools. No similar effect was found for students of other races/ethnicities; there were no differences by gender or by grade. Students in intervention schools were more likely to perceive other students as actively intervening in bullying incidents, and 6th graders were more likely to feel sorry and want to help victims.

Conclusion: The program had some mixed positive effects varying by gender, ethnicity/race, and grade but no overall effect. Schools implementing the program, especially with a heterogeneous student body, should monitor outcomes and pay particular attention to the impact of culture, race and family influences on student behavior. Future studies of large-scale bullying prevention programs in the community must be rigorously evaluated to ensure they are effective.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: US

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Intervention (n=4959) Relational Victimization: Pretest (n=4607); Posttest (n=4480) Physical Victimization: Pretest (n=4531); Posttest (n=4419) Control (n=1559) Relational Victimization: Pretest (n=1408); Posttest (n=1456) Physical Victimization: Pretest (n=1373); Posttest (n=1448)

Age Range: NR

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), PROVIDER/PRACTICE, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors obtained Medicaid eligibility, claims, and provider data before and after the fee increase, in 2006 and 2009 through 2012, respectively. Their analysis examined changes in utilization rates, service mix, expenditures, and dentists' participation. The authors qualitatively assessed the general impact of the recession on utilization rate changes.

Intervention Results: The percentage of preventive dental services among continuously enrolled children stayed relatively constant from pretest to posttest (24.1% in 2006 at pretest and 22.7%, 23.1%, 23.3%, and 24.4% in 2009, 2010, 2011, and 2012 respectively).

Conclusion: The Medicaid fee increase, program improvements, and the recession had a dramatic impact on reducing disparities in children's access to dental care in Connecticut.

Study Design: QE: pretest-posttest

Setting: Connecticut

Population of Focus: Children continuously enrolled in Medicaid (Healthcare for UninSured Kids and Youth A program) for at least 11 months and 1 day within a calendar year

Data Source: Medicaid enrollment and encounter data

Sample Size: 2006 (n=161,130) 2009 (n=166,787) 2010 (n=204,550) 2011 (n=215,377) 2012 (n=214,680)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Midwifery, PROVIDER/PRACTICE, HOSPITAL, Chart Audit and Feedback, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, Community — Outreach, Outreach, COMMUNITY, COMMUNITY

Intervention Description: To improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation.

Intervention Results: The CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience.

Conclusion: The CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.

Study Design: Time trend analysis

Setting: 1 public, medium-sized tertiary level obstetric unit

Population of Focus: Nulliparous women who gave birth between January 2006 and October 2015

Data Source: Not specified

Sample Size: n=~900 (880-924) per year

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Other Media, Community Events, Television Media, POPULATION-BASED SYSTEMS

Intervention Description: The project explored the potential of historically black medical schools to deliver health information to their local communities and used a community-based participatory research approach.

Intervention Results: Significant difference in Pap smear rates between Nashville (intervention) vs Chattanooga (control; 8% effect difference, p≤.01) but not between Atlanta (intervention) vs Decatur (control). Pooled results are not given.

Conclusion: This community intervention trial demonstrated modest success and are encouraging for future efforts of longer duration.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Nashville, TN; Atlanta, GA; Chattanooga, TN; and Decatur, GA

Population of Focus: Women living in predominantly black census tracts in the intervention cities

Data Source: Telephone interview

Sample Size: Baseline(n=4,053) Intervention (n=1,954); Control (n=2,099) Follow-up (n=3,914) Intervention (n=1,959); Control (n=1,955)

Age Range: ≥18

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): YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Presentation/Meeting/Information Session/Event, CLASSROOM, Enforcement of School Rules, SCHOOL, Bullying Committee, Assembly, Reporting & Response System, Teacher/Staff Meeting, Teacher/Staff Training, School Rules, Identification and Monitoring of/Increased Supervision in Targeted Areas, POPULATION-BASED SYSTEMS, COMMUNITY, Media Campaign (Print Materials, Radio, TV)

Intervention Description: This intervention study examined the prevalence of bullying in an urban/suburban middle school and the impact of the Olweus Bullying Prevention Program (OBPP).

Intervention Results: Statistically significant findings were found for 7th grade female students who received 1 year of the OBPP on reports of prevalence of bullying (p = .022) and exclusion by peers (p = .009). In contrast, variability in statistical findings was obtained for 8th grade females and no statistical findings were found for males. Following 1 year of the OBPP, teachers reported statistically significant improvements in their capacity to identify bullying (p = .016), talk to students who bully (p = .024), and talk with students who are bullied (p = .051). Other substantial percentile changes were also noted.

Conclusion: Findings suggest a significant positive impact of the OBPP on 7th grade females and teachers. Other grade and gender findings were inconsistent with previous literature. Recommendations for further research are provided along with implications for school health prevention programming.

Study Design: QE: time-lagged age-equivalent control group

Setting: US

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Intervention (n=112); Control (n=158)

Age Range: NR

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): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Follow-Up Given On Transferred Patients, STATE, Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Description: To determine whether perinatal care in southwestern Ontario is regionalized, to identify trends over time in referral patterns, to quantify trends in perinatal death rates and to identify trends in perinatal death rates that give evidence of regionalization.

Intervention Results: Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985.

Conclusion: Perinatal care in southwestern Ontario is regionalized and not centralized; regionalization in southwestern Ontario increased between 1982 and 1985.

Study Design: QE: pretest-posttest

Setting: Southwestern Ontario One level III, one modified level III and 30 level II or I

Population of Focus: Births greater than 500 gm

Data Source: Data obtained from hospital delivery room books and for 31 of the 32 hospitals, from hospital charts of women and neonates.

Sample Size: Pretest: 1.17% (n= 194) Posttest: 1.31% (n= 211) Infants born weighing 500-1499 gm

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Clinical Decision Support System, PROVIDER/PRACTICE, Public Insurance (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS

Intervention Description: To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices.

Intervention Results: Significant increase in percentage of children screened with a standardized screening tool at target visits (85% vs 24.4%, P<.001)

Conclusion: Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age.

Study Design: RCT

Setting: Four primary care pediatric clinics in the Eskenazi Medical Group in Indianapolis, Indiana

Population of Focus: Children younger than 66 months

Data Source: Child medical record

Sample Size: Medical records - Intervention (n=180) - Control (n=180)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy, Provider Training/Education

Intervention Description: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

Intervention Results: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

Conclusion: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 18 Local Health Authorities (LHAs) in 9 regions of Italy

Population of Focus: Women living in the area covered by LHA, with infants > 2000g, who spoke Italian, English, French, or Spanish (or who had a relative who spoke these languages), and without a postpartum condition that required admission to the NICU

Data Source: Mother self-report

Sample Size: Early Intervention Group5 • Enrolled (n=2846) • 12-month follow-up (n=2474) Late Intervention Group • Enrolled (n=2248) • 12-month follow-up (n=1931)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: This study assessed the impact of revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on nutritional behavior and obesity in children 0- to 4-years-old participating in the New York State (NYS) WIC program.

Intervention Results: Significant increase in breastfeeding initiation between JulyDec 2008 (72.2%) and July-Dec 2011 (77.5%) (p<.05)

Conclusion: These findings demonstrate that positive changes in dietary intake and reductions in obesity followed implementation of the USDA-mandated cost-neutral revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program.

Study Design: Time trend analysis

Setting: New York State (NYS)

Population of Focus: Mothers of infants and children through 4 years enrolled in the NYS WIC program between July 1, 2008-December 31, 2008

Data Source: New York State WIC Statewide Information System; Mother self-report

Sample Size: Pre-Implementation • July-Dec 2008 (n=179,929) During and Post-Implementation • Jan-Jun 2009 (n=186,451) • July-Dec 2009 (n=188,622) • Jan-Jun 2010 (n=186,663) • July-Dec 2010 (n=186,012) • Jan-Jun 2011 (n=184,262) • July-Dec 2011 (n=183,656)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.

Intervention Results: The percentage of established CHIP enrollees (continuously enrolled for at least 12 months) having had a dental visit for checkup or cleaning in the past year was 38% higher (p≤0.01) than recent enrollees who were uninsured for 5 to 12 months before enrollment and 5.3% higher (p≤0.05) than recent enrollees who were privately insured for 12 months before enrollment.

Conclusion: Enrolling eligible uninsured children in CHIP led to improvements in their access to preventive dental care, as well as reductions in their unmet dental care needs, yet the CHIP program has more work to do to address the oral health problems of children.

Study Design: QE: nonequivalent control group

Setting: AL, CA, FL, LA, MI, NY, OH, TX, UT, VA

Population of Focus: Children aged 18 years or younger enrolled in CHIP

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=5,518) Recent enrollees (n=4,142)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, Television Media, COMMUNITY, PATIENT/CONSUMER, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: To test the effectiveness of a community intervention program to promote breast and cervical cancer screening.

Intervention Results: There were higher Pap smear completion rates for women under 40 years of age in the intervention community.

Conclusion: Although it is important to address the cultural needs of all Mexican American women, it is also important to understand the tangible environmental barriers faced by the older women.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Predominantly Mexican American neighborhoods in San Antonio and Houston, TX

Population of Focus: Mexican American women

Data Source: Self-report through personal interviews

Sample Size: Baseline (n=1,776) Intervention (n=882); Control (n=894) First Panel Follow-up (n=296) Intervention (n=153); Control (n=143) Second Panel Follow-up (n=145) Intervention (n=70); Control (n=75)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Other Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: Evaluate the effect of an educational intervention on four domains of health care utilization and cervical cancer prevention and screening in a Hispanic population.

Intervention Results: Educational interventions designed to meet the needs identified by the sample group led to an increase in HPV awareness throughout the entire population surveyed and an increase in health care service utilization and HPV vaccine acceptance for women living in the US for <5 years.

Conclusion: These tools should be promoted to reduce the cervical cancer burden on vulnerable populations.

Study Design: QE: pretest-posttest

Setting: Boston, MA

Population of Focus: Hispanic women in the Boston area

Data Source: Written survey in English or Spanish

Sample Size: Baseline (n=318) Follow-up (n=295)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Reorganization of Neonatal Services, NATIONAL, POPULATION-BASED SYSTEMS

Intervention Description: To assess the impact of reorganisation of neonatal specialist care services in England after a UK Department of Health report in 2003.

Intervention Results: After reorganisation, there were increases in the proportions of babies born at 27-28 weeks' gestation in hospitals providing the highest volume of neonatal specialist care (18% (631/3495) v 49% (1325/2724); odds ratio 4.30, 95% confidence interval 3.83 to 4.82; P<0.001) and in acute and late postnatal transfers (7% (235) v 12% (360) and 18% (579) v 22% (640), respectively; P<0.001). There was no significant change in the proportion of babies from multiple births separated by transfer (33% (39) v 29% (38); 0.86, 0.50 to 1.46; P=0.57). In epoch two, 32% of acute transfers were to a neonatal unit providing either an equivalent (n=87) or lower (n=26) level of specialist care.

Conclusion: There is evidence of some improvement in the delivery of neonatal specialist care after reorganisation.

Study Design: QE: pretest-posttest

Setting: Pretest: 294 maternity centers and neonatal units in England, Wales and Northern Ireland Posttest: 146 neonatal units (23 managed clinical networks) in England

Population of Focus: Infants born at 27+0 to 28+6 (weeks+ days) GA In pretest, live births In posttest, admitted to a neonatal unit (no details on babies who died in labor ward)

Data Source: Pretest: Data from a published report of the Confidential Enquiry into Stillbirths and Deaths in Infancy Project 27/28 which identified 28 day outcomes of all live births at 27-28 weeks GA in England, Wales, and Northern Ireland. Posttest: Data from National Neonatal Research Database held by the Neonatal Data Analysis Unit.

Sample Size: Pretest (n=3,522) Posttest (n=2,919)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Sleep Environment Modification, Promotional Event, POPULATION-BASED SYSTEMS, COMMUNITY, Social Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Community)

Intervention Description: To improve sleep environment safety for inpatient infants.

Intervention Results: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Study Design: QE: pretest-posttest

Setting: University of Iowa Children’s Hospital

Population of Focus: Infants less than 1 year of age developmentally ready for a crib and asleep

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Labor Support, POPULATION-BASED SYSTEMS, STATE, Place of Birth, HEALTH_CARE_PROVIDER_PRACTICE, Midwifery

Intervention Description: The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes.

Intervention Results: The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58-0.83; multiparas: OR: 0.34, 95% CI: 0.23-0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26-0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41-0.53; multiparas: OR: 0.25, 95% CI: 0.20-0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59-0.87; multiparas: OR: 0.45, 95% CI: 0.29-0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14-1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55-0.98; multiparas: OR: 0.41, 95% CI: 0.20-0.83).

Conclusion: Midwife-led comprehensive care with the same medical guidelines as in standard care reduced medical interventions without jeopardizing maternal and infant health.

Study Design: Retrospective cohort

Setting: 1 large, public hospital

Population of Focus: Nulliparous women admitted to the modified birth center between March 2004 to July 2008 who gave birth at either the modified birth center or in standard delivery ward2

Data Source: Not specified

Sample Size: Total (n=6,141) Intervention (n=1,263) Control (n=4,878)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Modified Billing Practices, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Collaboration with Local Agencies (State), STATE, POPULATION-BASED SYSTEMS

Intervention Description: As part of a larger randomized study of the Healthy Families America home visiting program being conducted in Oregon (Healthy Families Oregon, HFO), we conducted a telephone survey with a randomly selected group of mothers to assess early outcomes at children's 1-year birthday.

Intervention Results: Results found that mothers assigned to the Healthy Families program group read more frequently to their young children, provided more developmentally supportive activities, and had less parenting stress. Children of these mothers were more likely to have received developmental screenings, and were somewhat less likely to have been identified as having a developmental challenge. Families with more baseline risk had better outcomes in some areas; however, generally there were not large differences in outcomes across a variety of subgroups of families.

Conclusion: Implications of these results for understanding which short-term program impacts are most feasible for early prevention programs, as well as for understanding how these services might be better targeted are discussed.

Study Design: RCT

Setting: Seven Health Families Oregon program sites in Oregon

Population of Focus: First-born children from birth through 36 months of age

Data Source: Parent telephone survey

Sample Size: Telephone surveys (n=803 mothers) - Intervention (n=402) - Control (n=401)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), PROVIDER/PRACTICE, POPULATION-BASED SYSTEMS, STATE, Medicaid Reform, Education/Training (caregiver), Provider Training/Education

Intervention Description: This study aimed to determine the Washington State's Access to Baby and Child Dent stry (ABCD) Program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge.

Intervention Results: Children in the ABCD program had a mean of 10.27 preventive dental services compared to 0.24 among children not in the ABCD program (p=0.00).

Conclusion: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Study Design: QE: nonequivalent control group

Setting: Spokane County in WA

Population of Focus: Children aged 12-36 months enrolled in Medicaid as of August 31, 1997

Data Source: Parent survey

Sample Size: Intervention (n=228) Control (n=237)

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): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth, Childbirth Education Classes, Midwifery, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Intervention Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Conclusion: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Study Design: Retrospective cohort

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between April 2004 to October 20102

Data Source: Not specified

Sample Size: Total (n=1,660) Intervention (n=830) Control (n=830)

Age Range: Not Specified

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

Intervention Description: We examined the impact of state breastfeeding laws on breastfeeding initiation and duration as well as on disparities in these infant feeding practices.

Intervention Results: Breastfeeding initiation was 1.7 percentage points higher in states with new laws to provide break time and private space for breastfeeding employees (p=0.01), particularly among Hispanic mothers (adjusted coefficient 0.058). While there was no overall effect of laws permitting mothers to breast feed in any location, among Black mothers we observed increases in breastfeeding initiation (adjusted coefficient 0.056). Effects on breastfeeding duration were in the same direction, but slightly weaker.

Conclusion: State laws that support breast feeding appear to increase breastfeeding rates. Most of these gains were observed among Hispanic and Black women and women of lower educational attainment suggesting that such state laws may help reduce disparities in breast feeding.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: All mothers at 4 months postpartum

Data Source: Pregnancy Risk Assessment Monitoring System (PRAMS)

Sample Size: 2000 (n=30,899) 2008 (n=36,512)

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): 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, Perinatal Committees/Councils, STATE

Intervention Description: A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population.

Intervention Results: The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa. Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Conclusion: The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 130 level I, 10 level II, and one level III hospital Posttest: 122 level I, 10 level II, and one level III hospital

Population of Focus: All live births <1500 gm

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

Sample Size: Pretest (n= 440) Posttest (n= 402)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities)

Intervention Description: To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates.

Intervention Results: The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of "feeling liked." The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19-1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race.

Conclusion: Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates.

Study Design: QE: non-equivalent control group

Setting: 4 WIC clinics in Chickasaw Nation, OK

Population of Focus: Parents and caregivers who were pregnant or had a child ≤ 3 years old

Data Source: Mother self-report

Sample Size: Intervention (n=846) Control (n=807)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, POPULATION-BASED SYSTEMS, NATIONAL, Campaign, Mass Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To assess parental risk behaviour before and after a sudden infant death syndrome (SIDS) information campaign with special emphasis on associations with maternal age, education, marital status and birth order.

Intervention Results: The prevalence of non-supine sleep position decreased significantly from 33.7% before the campaign to 13.6% after (RR=0.40, 95% CI: 0.37-0.44). The decrease was significant by maternal education, cohabitation, birth order, and maternal age.

Conclusion: Non-supine sleeping decreased to a level that has never been reported before. In future campaigns, subgroup-specific measures may be needed.

Study Design: QE: pretest-posttest

Setting: N/A

Population of Focus: All mothers registered with the Medical Birth Registry of Norway as having given birth between Oct and Nov 1998 and Oct and Nov 1999 without a pathological condition

Data Source: Mother report

Sample Size: Baseline (n=5539) Follow-up (n=4143)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, COMMUNITY, Other (Communities), POPULATION-BASED SYSTEMS

Intervention Description: To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.

Intervention Results: The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found.

Conclusion: A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.

Study Design: Pragmatic cluster RCT

Setting: 14 clusters of general practices

Population of Focus: Clusters of general practices that collected breastfeeding data through the Child Health Surveillance Program of the National Health Service Scotland from Oct 2002 forward

Data Source: Child Health Surveillance Programme

Sample Size: Intervention (n=7) Control (n=7) N=Clusters

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Agreement for Level III Hospital to Accept All Patients, Medical Staff Integration

Intervention Description: Not available

Intervention Results: After the intervention, there was a statistically significant decrease in the number of VLBW infants born in a level II hospital (p<0.01).

Conclusion: Not available

Study Design: QE: pretest-posttest

Setting: Minnesota: Abbott-Northwestern/ Minneapolis Children’s Perinatal Center and Fairview-Southdale Hospital (Level II)

Population of Focus: All births at level II hospital

Data Source: Data source not provided.

Sample Size: Pretest (n= 2,573) Posttest (n= 2,722)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Television Media, POPULATION-BASED SYSTEMS

Intervention Description: Evaluate the impact of a Coronation Street story line, in which one of the characters died from cervical cancer, on the National Health Service (NHS) Cervical Screening Programme.

Intervention Results: 21.3% increase in number of Pap smears during study period in 2001 than same time period in 2000 (95% CI: 21.0%-21.6%)

Conclusion: We have demonstrated a large impact of a soap opera story line on the cervical screening programme although the benefit to health is not clear. Further research will determine the long-term effect of the story.

Study Design: QE: pretest-posttest

Setting: Lancashire and Greater Manchester zones of the North West Region of the National Health Service

Population of Focus: Women whose previous Pap smear was normal and who were on routine recall during the intervention period

Data Source: Health Authority cervical screening databases

Sample Size: Total (N=320,128)5 N= Pap smears

Age Range: ≥25

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Three California counties (Los Angeles, San Mateo, and Santa Clara) expanded health insurance coverage for undocumented children and some higher income children not covered by Medi-Cal (Medicaid) or Healthy Families (SCHIP). This paper presents findings from evaluations of all three programs.

Intervention Results: Results consistently showed that health insurance enrollment increased access to and use of medical and dental care, and reduced unmet need for those services.

Conclusion: After one year of enrollment the programs also improved the health status of children, including reducing the percentage of children who missed school due to health.

Study Design: QE: nonequivalent control group

Setting: Los Angeles, San Mateo, and Santa Clara, CA

Population of Focus: Children aged 1-5 years in Los Angeles and those aged 1-18 years in San Mateo and Santa Clara enrolled in the Healthy Kids program

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=1,842) New enrollees (n=1,879)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: To examine the changes in breastfeeding practices in California relative to other states before and after the implementation of PFL.

Intervention Results: An increase of 3-5 percentage points for exclusive breastfeeding and an increase of 10-20 percentage points for breastfeeding at several important markers of early infancy.

Conclusion: Our study supports the recommendation of the Surgeon General to establish paid leave policies as a strategy for promoting breastfeeding.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: Healthy women ≥ 18 years old at prenatal questionnaire administration, with full or nearly full-term singleton birth weighing ≥ 5lbs

Data Source: Mother self-report from the Infant Feeding Practices Study

Sample Size: Wave 1, 1993 (n=704) Wave 2, 2005-2006 (n=1324)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Guideline Change and Implementation, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: To determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates.

Intervention Results: The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among vaginal birth after cesarean section (VBAC) -eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged.

Conclusion: The program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.

Study Design: Time trend analysis

Setting: 1 small, rural hospital

Population of Focus: Nulliparous women who gave birth between January 1985 and December 19892

Data Source: Not specified

Sample Size: n=456

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: We analyze changes in breastfeeding among WIC participants from the period before to period after implementation of the new food package.

Intervention Results: No statistically significant trends in breastfeeding after implementation of the new WIC food package

Conclusion: Rates of ever breastfed children are rising nationally but the increase is not associated with changes in WIC's new food package as evidenced in national and state surveys of postpartum women.

Study Design: Time trend analysis

Setting: National

Population of Focus: Intervention: women who participated in WIC during pregnancy Control: women not on WIC during pregnancy of similar socioeconomic status

Data Source: PRAMS, National Immunization Survey and the Pediatric Nutrition Surveillance System

Sample Size: N/A8

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002.

Intervention Results: Established Medicaid enrollees were 12 and 16 percentage points more likely to receive a dental visit for checkup/cleaning than all recent enrollees and recent enrollees who were previously uninsured for 6 months prior to enrollment (p<0.05). Established enrollees were not more likely to receive preventive dental visits than recent enrollees who were insured for some or all of the 6 months prior to enrollment.

Conclusion: Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Study Design: QE: nonequivalent control group Kulkarni (2013) Canada City-operated child care centers or Ontario Early Years Centers in Toronto Young children (no exclusion criteria) Study group (n=161) Control group (n=181) Prospective coh

Setting: CA and NC

Population of Focus: Children older than 3 years enrolled in Medicaid or SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Established enrollees (n=830) Recent enrollees (n=332)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees.

Intervention Results: SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups.

Conclusion: Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: CA, CO, FL, IL, LA, MO, NJ, NY, NC, TX

Population of Focus: Children older than 3 years enrolled in SCHIP in 2002

Data Source: Parent telephone survey

Sample Size: Intervention (n=4,953) Control (n=840)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, PATIENT/CONSUMER, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: Assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.

Intervention Results: Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

Conclusion: TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.

Study Design: QE: pretest-posttest

Setting: All Arkansas hospitals (Nine selected as telemedicine hospitals due to high patient volume)

Population of Focus: Infants born weighing <1500 gm

Data Source: Medicaid data for VLBW infants as indicated by ICD-9 diagnosis codes from hospital and physician claims for pregnancy. Data infant with birth and infant death certificates.

Sample Size: Pretest (n= 383) Posttest (n= 384)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, POPULATION-BASED SYSTEMS, STATE, WIC Food Package Change

Intervention Description: The effect of the new Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package, implemented in October 2009, on breastfeeding outcomes among a predominately Latina sample of WIC participants in Los Angeles County, California.

Intervention Results: Small but significant increases from pre- to postimplementation of the new WIC food package in prevalence of prenatal intention to breastfeed and breastfeeding initiation, but no changes in any breastfeeding at 3 and 6 months. The prevalence of exclusive breastfeeding at 3 and 6 months roughly doubled, an increase that remained large and significant after adjustment for other factors.

Conclusion: The new food package can improve breastfeeding outcomes in a population at high risk for negative breastfeeding outcomes.

Study Design: QE: pretest-posttest

Setting: Los Angeles County, CA

Population of Focus: Mothers participating in WIC who spoke English or Spanish

Data Source: Mother self-report

Sample Size: 2005 (n=1772) 2008 (n=1598) 2011 (n=1650)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Public Insurance (State)

Intervention Description: To determine the impact of children's health insurance programs on access to health care and on other aspects of the lives of the children and their families.

Intervention Results: Among the continuously enrolled children, preventive dental visits increased from 34.2% to 55.6% between enrollment and 6 months post-enrollment (p<0.005). Between 6 months post-enrollment and 12-months post-enrollment, it increased from 55.6% to 61.5% (p<0.005). The increase from enrollment to 12-months post enrollment was significant (p<0.005). Comparison children at enrollment (28.5%) had a lower percentage of preventive dental visits than continuously enrolled children at enrollment (34.2%); therefore, the changes observed in the study group were attributable to the insurance programs rather than to other environmental trends.

Conclusion: Extending health insurance to uninsured children had a major positive impact on children and their families. In western Pennsylvania, health insurance did not lead to excessive utilization but to more appropriate utilization.

Study Design: Time trend analysis

Setting: Western PA

Population of Focus: Children up to 19 years in families with incomes less than 235% FPL enrolled in the Children’s Health Insurance Program of Pennsylvania (BlueCHIP) and the Highmark Blue Cross Blue Shield Caring Program (Caring)

Data Source: Parent telephone survey

Sample Size: Study group (n=1,031) Comparison group (n=460)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Elective Induction Policy, Guideline Change and Implementation, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery.

Intervention Results: Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR = 4.1, 95% CI [1.3–12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR = 3.2 [1.0–10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor.

Conclusion: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.

Study Design: Retrospective cohort

Setting: 138 maternity units

Population of Focus: Nulliparous women who gave birth between June 2001 and May 20022

Data Source: Not specified

Sample Size: Total (n=2,052) Intervention (n=69) Control (n=1,983)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Increased Reimbursement, STATE, POPULATION-BASED SYSTEMS

Intervention Description: Objective was to determine whether perinatal referral patterns and clinical outcomes for very low birthweight infants changed in relation to changing Medicaid financial policies in coastal South Carolina.

Intervention Results: A decrease in the proportion of nonwhite very low birthweight infants was identified. There was an increase in very low birthweight infants with Medicaid funding born outside our level III center.

Conclusion: Changes in financial public policy have been successful in the movement of low risk pregnancies into the private sector. However, an increased proportion of deliveries of very low birthweight infants occurred outside the level III center.

Study Design: QE: pretest-posttest

Setting: All coastal South Carolina hospitals: Includes one level III hospital

Population of Focus: Infants born weighing <1500 gm

Data Source: Data source not provided.

Sample Size: Pretest (n= 255) Posttest (n= 265)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Maternal/In-Utero Transport Systems, INTER-HOSPITAL SYSTEMS, POPULATION-BASED SYSTEMS, Consultation Systems (Inter-Hospital Systems), Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Description: The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia.

Intervention Results: There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.

Conclusion: Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.

Study Design: QE: pretest-posttest

Setting: New South Wales, Australia hospitals Seven perinatal centers

Population of Focus: Infants born between 23+0 and 28+6 weeks GA who did not die before or during retrieval.

Data Source: Baseline population data for all births between 23 and 28 weeks GA obtained from the New South Wales Midwives Data Collection.

Sample Size: Pretest (n= 1,778) Posttest (n= 3,099)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

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, 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): Campaign, NATIONAL, POPULATION-BASED SYSTEMS

Intervention Description: The objective of this study was to compare rates of infant sleeping position and other risk factors for sudden infant death syndrome from 1991 before the "Back to Sleep" campaign to rates in 1998 after the campaign.

Intervention Results: In North Dakota the prevalence rates of prone sleeping declined 72% for American Indian infants and 62% for Caucasian infants. We were unable to identify a corresponding decline in SIDS in North Dakota for this time period.

Conclusion: The relationship between sleeping position and SIDS may be more complex in rural and frontier settings and in American Indian populations than in urban and majority populations. The generalizability of this study is limited by the rural setting and small sample size. Longer term surveillance and additional reports from sites with pre "Back to Sleep" data as a baseline for both SIDS rates and sleeping position will be important to clarify the rate of prone sleeping position and SIDS.

Study Design: QE: pretest-posttest

Setting: North Dakota

Population of Focus: Caretakers of infants ≤6 months of age

Data Source: Caregiver report

Sample Size: Baseline (n=324) Follow-up (n=273)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Peer-led Mentoring/Support Counseling, CLASSROOM, Presentation/meeting/information Session (Classroom), SCHOOL, Assembly, Media Campaign (Print Materials, Public Address System, Social Media), POPULATION-BASED SYSTEMS, COMMUNITY, Event, Outreach

Intervention Description: An investigation of whether and to what extent a peer-led model is able to counteract mechanisms underlying bullying in peer groups, seeking clarification of divergence in reported results on the efficacy of peer-led models.

Intervention Results: Two studies were carried out in Italy within a project tackling bullying and cyberbullying in secondary schools. In the first study (n= 386), concerning the first phase of the project, a significant decrease was found only for cyberbullying, most of all for male peer educators. For the second study (n= 375) the model was improved and significant effects were found for several participating groups (peer educators and the experimental classes), who exhibited a decrease in bullying, victimization, and cybervictimization.

Conclusion: Results suggest that peer educators can act as agents of change in the broader context.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Italy

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Study 1: Intervention 1 (n=126); Intervention 2 (n=63); Control (n=47) Study 2: Intervention (n=231); Control (n=144)

Age Range: 14-20

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded.

Intervention Results: Before the intervention, the adjusted proportion of pregnant women with a dental service claim was 0.36. After the intervention, the proportion of pregnant women with a dental service claim declined to 0.22 (p<0.001).

Conclusion: Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: The mass media has been shown to be effective at improving participation in cervical screening. A 2007 television advertising campaign to promote cervical screening in New South Wales (NSW) was examined.

Intervention Results: Significant increase in mean number of screens per week in intervention period than same period in previous year (17% difference, t-value=3.84)

Conclusion: Despite the ecological nature of this study, the mass media campaign appears to have been successful in increasing screening in unscreened and underscreened women in NSW.

Study Design: QE: pretest-posttest design

Setting: New South Wales

Population of Focus: Women in New South Wales

Data Source: New South Wales Pap Test Register

Sample Size: Approximate total (N≈27,100) 2006 (n=12,284) 2007 (n=14,816) N=mean Pap smears per week

Age Range: 20-69

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Enabling Services, Other Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: A 48-month community intervention was conducted to improve breast and cervical cancer (BCC) screening among Korean American (KA) women in Alameda County (AL), California. KA women in Santa Clara (SC) County, California served as a comparison group.

Intervention Results: After adjusting for all covariates, no significant difference in Pap smear rates between intervention and comparison counties.

Conclusion: Although our overall intervention did not appear to enhance screening practices at the community-level, attendance at a women's health workshop appears to have increased cervical cancer screening.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Alameda County and Santa Clara County, CA

Population of Focus: Korean American women

Data Source: Telephone survey

Sample Size: Total (N=2,176) Baseline (n=1,093); Follow-up (n=1,083) Analysis (participated in baseline or follow-up) (n=1,902) Baseline (n=818) Intervention (n=404); Control (n=414) Follow-up (n=1,084) Intervention (n=418); Control (n=458)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.

Intervention Results: Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas.

Conclusion: Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Intervention: CT, MD, TX Control: CA, FL, HI, IL, MA, ME, MO, MI, ND, OR, PA, UT, WA, WI

Population of Focus: Children aged 1-17 years eligible for Medicaid

Data Source: 2007 and 2011-2012 National Survey of Children’s Health

Sample Size: NR

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Patient Navigation, Enabling Services, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education, Designated Clinic/Extended Hours, Female Provider, COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Intervention Results: Significantly greater odds of Pap smear for women in intervention county than in control county (OR=2.02, 95% CI: 1.37-2.99)

Conclusion: A multifaceted community-based participatory research (CBPR) intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Santa Clara County, CA and Harris County, TX

Population of Focus: Vietnamese women living in either county

Data Source: Computer-assisted telephone interviewing system

Sample Size: Baseline(n=1,566) Intervention (n=798); Control (n=768) Follow-up (n=2,009) Intervention (n=1,004); Control (n=1,005)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina.

Intervention Results: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000.

Conclusion: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.

Study Design: QE: pretest-posttest

Setting: South Carolina

Population of Focus: Children aged 2-21 years enrolled in Medicaid

Data Source: Medicaid claims

Sample Size: 1998 (n=377,690) 1999 (n=447,069) 2000 (n=504,642)

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.

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Peer-led Mentoring/Support Counseling, CLASSROOM, Presentation/meeting/information Session (Classroom), Peer-led Curricular Activities/Training, SCHOOL, Assembly, Media Campaign (Print Materials, Public Address System, Social Media), POPULATION-BASED SYSTEMS, COMMUNITY, Event, Presentation

Intervention Description: The NoTrap! (Noncadiamointrappola!) program is a school-based intervention, which utilizes a peer-led approach to prevent and combat both traditional bullying and cyberbullying. The aim of the present study was to evaluate the efficacy of the third Edition of the program in accordance with the recent criteria for evidence-based interventions.

Intervention Results: Towards this aim, two quasi-experimental trials involving adolescents (age M = 14.91, SD = .98) attending their first year at different high schools were conducted. In Trial 1 (control group, n = 171; experimental group, n = 451), latent growth curve models for data from pre-, middle- and post-tests showed that intervention significantly predicted change over time in all the target variables (victimization, bullying, cybervictimization, and cyberbullying). Specifically, target variables were stable for the control group but decreased significantly over time for the experimental group. Long-term effects at the follow up 6 months later were also found. In Trial 2 (control group, n = 227; experimental group, n = 234), the moderating effect of gender was examined and there was a reported decrease in bullying and cyberbullying over time (pre- and post-test) in the experimental group but not the control group, and this decrease was similar for boys and girls.

Conclusion: The significant improvement in target variables in trials of the third edition, compared to the non-significant improvements found for the first and second editions, suggests that the new/modified components may have improved the efficacy of the program.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Italy

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Total (n=375) Intervention (n=231); Control (n=144)

Age Range: 14-18

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Peer-led Mentoring/Support Counseling, CLASSROOM, Presentation/meeting/information Session (Classroom), SCHOOL, Assembly, Media Campaign (Print Materials, Public Address System, Social Media), POPULATION-BASED SYSTEMS, COMMUNITY, Event, Presentation

Intervention Description: The aim of the present study is to describe and evaluate an ongoing peer-led model against bullying and cyberbullying carried out with Italian adolescents.

Intervention Results: Results showed a significant decrease in the experimental group as compared to the control group for all the variables except for cyberbullying. Besides, in the experimental group we found a significant increase in adaptive coping strategies like problem solving and a significant decrease in maladaptive coping strategies like avoidance: these changes mediate the changes in the behavioural variables. In particular, the decrease in avoidance predicts the decrease in victimization and cybervictimization for peer educators and for the other students in the experimental classes whereas the increase in problem solving predicts the decrease in cyberbullying only in the peer educators group.

Conclusion: Results are discussed following recent reviews on evidence based efficacy of peer led models.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Italy

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Trial 1: Intervention (n=451); Control (n=171) Trial 2: Intervention (n=234); Control (n=227)

Age Range: Mean: ~16.23

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: This observational study investigated whether dietary intake and feeding practices of a sample of majority-Hispanic infants and toddlers participating in a WIC clinic in south central Texas improved after the revised food package changes.

Intervention Results: Significantly fewer infants received cereal in their bottles and fewer toddlers consumed vegetables and eggs after the package changes. The observed feeding practices of infants and toddlers among this sample did not reflect the WIC package changes.

Conclusion: Strategic and comprehensive breastfeeding and nutrition education are recommended. Package modifications such as adding eggs back to the toddler package and allowing more flexibility for purchasing fresh produce and baby foods may be warranted.

Study Design: QE: pretest-posttest

Setting: WIC clinic in south central TX

Population of Focus: Spanish and English-speaking caregivers of infants and toddlers

Data Source: Mother self-report

Sample Size: 2009 (n=84) 2011 (n=112)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, CLASSROOM, Adult-led Curricular Activities/Training, Enforcement of School Rules, Notification/Information Materials (Online Resources, Information Guide), SCHOOL, Bullying Committee, Reporting & Response System, Teacher/Staff Training, School Rules, POPULATION-BASED SYSTEMS, COMMUNITY, Media Campaign (Print Materials, Radio, TV), Presentation

Intervention Description: The goal of this large population-based initiative was to reduce bullying by producing a quantifiable change in school climate using an established program and standardized measurement tool.

Intervention Results: After 1 to 2 years of program implementation, across cohorts, there were reductions in student self-reports of bullying others, and improvements in student perceptions of adults' responsiveness, and students' attitudes about bullying.

Conclusion: This initiative reaffirms the efficacy of the OBPP, emphasizes the importance of an identified coalition, and highlights several positive outcomes. It is recommended that the OBPP be implemented through the establishment of community partnerships and coalitions as consistent with the public health model.

Study Design: QE: pretest-posttest age-equivalent cohort

Setting: US

Population of Focus: Not specified

Data Source: Not specified

Sample Size: HALT! Schools Cohort 1: Middle school (n=0); High school (n=999) Cohort 2: Middle school (n=12972); High school (n=7436) PA CARES Schools: Middle school (n=9899); High School (n=6048)

Age Range: NR

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM, Peer-led Curricular Activities/Training, SCHOOL, Assembly, Media Campaign (Print Materials, Public Address System, Social Media), POPULATION-BASED SYSTEMS, COMMUNITY, Training, Event, Media Campaign (Print Materials, Radio, TV), Distribution of Promotional Items (Classroom/School), Distribution of Promotional Items (Community)

Intervention Description: In a community randomized controlled trial, intervention middle school students from small towns were exposed to a community and school-based anti-violence intervention ("Resolve It, Solve It").

Intervention Results: Students in the intervention group reported a significantly higher rate of decline in verbal victimization compared to control students. The difference was only significant among males. For physical victimization, the decline in the intervention group compared to the control group was in the expected direction but did not reach statistical significance (p=0.069). This near significant difference was accounted for by males.

Conclusion: These results suggest that a media and reinforcing community intervention led by older peers can alter rates of growth for some measures of violence and associated factors among small-town youth. Further research is indicated to determine how different campaign messages influence students by sex.

Study Design: Cluster RCT: pretest-posttest

Setting: US

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Total (n=1492) Intervention (n=712); Control (n=780)

Age Range: NR

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Patient Navigation, Enabling Services, COMMUNITY, Community Events, POPULATION-BASED SYSTEMS, Home Visits

Intervention Description: A group-randomized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle’s Cambodian refugee community.

Intervention Results: The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up (+17%). The corresponding proportions among the control group were 51 and 62% (+11%). These temporal increases were statistically significant in both the intervention (P < 0.001) and control (P = 0.027) groups.

Conclusion: This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group; rather, we found an increase in both intervention and control groups. A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates.

Study Design: Cluster RCT

Setting: Seattle, Washington

Population of Focus: Cambodian women

Data Source: Self-report through personal interviews and verified through medical record review

Sample Size: Total (N=370) Analysis (n=289) Intervention (n=144); Control (n=145)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Other Person-to-Person Education, Enabling Services, Other Media, Community Events, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: In a randomized controlled trial of 20 communities, the study examined whether a comprehensive intervention influenced cancer screening behaviors and lifestyle practices in rural communities in Eastern Washington State. Cross-sectional surveys at baseline and post-intervention included interviews with a random sample of approximately 100 households per community. The interview included questions on ever use and recent use of Pap test, mammogram, and fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy, fruit and vegetable consumption and smoking practices.

Intervention Results: The study found few significant changes in use of screening services for cervical (Pap test), breast (mammogram) or colorectal cancer (fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy) between intervention and control communities. Results showed no significant differences in fruit and vegetable consumption nor in smoking prevalence between the two groups. We found more awareness of and participation in intervention activities in the treatment communities than the control communities.

Conclusion: Our null findings might be attributable to the low dose of the intervention, a cohort effect, or contamination of the effect in non-intervention communities. Further research to identify effective strategies to improve cancer prevention lifestyle behaviors and screening practices are needed.

Study Design: Cluster RCT

Setting: Twenty communities in the Lower Yakima Valley of WA

Population of Focus: Women

Data Source: Self-report through personal interviews

Sample Size: Total (N=1,962) Analysis (n=1,851) Intervention (n=894); Control (n=957)

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

Intervention Description: Analysis of a maternal transport service within a perinatal region.

Intervention Results: Analysis of perinatal statistics from the Loyola University Perinatal Center from 1979 to 1986 supports: (1) increasing numbers of maternal and neonatal transports, with the number of maternal transports exceeding the number of neonatal transports since 1982; (2) increasing proportion of low birthweight and very low birthweight infants delivered at the perinatal center; (3) a decrease in the number of infants less than 1500 gm sent as neonatal transports; and (4) increasing proportion of neonatal transports with a birthweight greater than 2500 gm.

Conclusion: The perinatal mortality rate for the region has decreased from 1981 to 1986.

Study Design: Time trend analysis

Setting: Metropolitan Chicago: Cook County and Suburban Dupage County Two level I, 11 level II, and one level III hospitals

Population of Focus: Infants born weighing >500 gm. Data for entire region only given from 1981-1986.

Data Source: Data obtained from the Illinois Department of Public Health and Loyola University annual statistics reports.

Sample Size: 1981 (n= 18,365) 1982 (n= 19,460) 1983 (n= 19,162) 1984 (n= 19,379) 1985 (n= 20,132) 1986 (n= 19,751)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONAL, POPULATION-BASED SYSTEMS

Intervention Description: The goal of this study was to assess the impact of eight French perinatal guidelines on actual obstetric practices.

Intervention Results: The percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P<0.0001). The overall caesarean rate climbed slowly but regularly from 1994 through 2006 (P<0.0001). Use of antenatal corticosteroids for women hospitalised for threatened preterm labour and in children born before 33 weeks has fluctuated since the release of the guideline (P>0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P<0.0001). The percentage of deliveries with active management of the third stage of labour rose notably from 1999 to 2006 (P<0.0001), and smoking cessation during pregnancy rose slightly in 2006 (P<0.0001). Since 1994, early discharges have become slowly, slightly, but regularly more frequent for all women (P<0.0001). The guideline on episiotomies has had a slight positive effect in the short term (P<0.0001).

Conclusion: Globally, the impact on actual practices of clinical practice guidelines, except the guideline concerning the active management of the third stage of labour, was low. Most of the changes observed in practices began before the pertinent guideline was published.

Study Design: Time trend analysis

Setting: French hospitals

Population of Focus: Subsample of all infants born weighing <1500 gm Data from 1994 to 1998 only included singleton pregnancies

Data Source: Data from the voluntary Audipog database in which participating hospitals send data on all deliveries covering a given period of at least a full month (chosen by hospital) each year. Authors extracted a subsample from the data.

Sample Size: Percentages given without numerator or denominator.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Medical Staff Integration

Intervention Description: To improve outcomes and maximize resource utilization, a regionalized system for high-risk perinatal and neonatal care is recommended.

Intervention Results: There was a significant decrease of 63% in the number of VLBW births at level II hospital after intervention (p-value and statistical test not indicated). The annual number of maternal transports to level III hospital increased 258% after intervention from an average of 38 per year to 98. The authors do not comment on statistical significance of this result.

Conclusion: With this process we were able to maintain a single level III subspecialty center, increase high-risk maternal transport, decrease neonatal transport, and limit VLBW deliveries outside of the level III subspecialty center.

Study Design: QE: pretest-posttest

Setting: Ohio, TriHealth Hospital System Two level II and one level III hospital

Population of Focus: Total sample size not given for pretest and posttest periods.

Data Source: Data from the National Institute of Child Health and Human Development Neonatal Research Network registry, the Regional Perinatal Database, and hospital records.

Sample Size: Total sample size not given for pretest and posttest periods.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): STATE/NATIONAL, WIC Food Package Change, POPULATION-BASED SYSTEMS, STATE

Intervention Description: The purpose of this study was to measure changes in the following 3 outcomes: WIC food-package assignments, WIC infant formula amounts, and breastfeeding initiation.

Intervention Results: There were changes in WIC food-package assignments and infant formula amounts but no change in breastfeeding initiation.

Conclusion: After the change, fewer WIC mothers of new infants received the partial breastfeeding package. More WIC mothers received the full breastfeeding package, but more mothers also received the full formula package.

Study Design: QE: pretest-posttest

Setting: 17 local WIC agencies in 10 states (CA, FL, GA, ID, IL, MN, RI, TN, TX & UT)

Population of Focus: All mothers with infants 0-5 months before and after intervention implementation

Data Source: Mother self-report

Sample Size: Months 1-2 – preintervention (n=17,597) Months 5-12 – postintervention (n=62,427)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Guideline Change and Implementation, HOSPITAL, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National), PROFESSIONAL_CAREGIVER, Consensus Guideline Implementation, HEALTH_CARE_PROVIDER_PRACTICE, Active Management of Labor

Intervention Description: To evaluate the rate of primary cesarean delivery after adopting labor management guidelines.

Intervention Results: Among women delivering after induction or augmentation, the cesarean delivery rate decreased from 35.5% to 24.5% (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.91). The overall cesarean delivery rate decreased from 26.9% to 18.8% (adjusted OR 0.59, CI 0.38-0.92). Composite maternal morbidity was reduced (adjusted OR 0.66, CI 0.46-0.94). The frequency of cesarean delivery documenting arrest of dilation at less than 6 cm decreased from 7.1% to 1.1% postguideline (n=182 and 176 preguideline and postguideline, respectively, P=.006) with no change in other indications.

Conclusion: Postguideline, the cesarean delivery rate among nulliparous women attempting vaginal delivery was substantially reduced in association with decreased frequency in the diagnosis of arrest of dilation at less than 6 cm.

Study Design: Retrospective cohort

Setting: 1 public university hospital in Pennsylvania

Population of Focus: Nulliparous women who gave birth between September 13, 2013 and February 28, 2014 and between May 1, 2014, to September 28, 2014

Data Source: Not specified

Sample Size: Total (n=567) Pre-intervention (n=275) Post-intervention (n=292)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Education, Provision of Breastfeeding Item, PROVIDER/PRACTICE, Hospital Policies, Other (Provider Practice), POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities), Provider Training/Education

Intervention Description: A breastfeeding promotion program conducted on the Navajo reservation.

Intervention Results: Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful.

Conclusion: This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Study Design: QE: pretest-posttest

Setting: Shiprock, NM

Population of Focus: All mothers with infants born at the Shiprock hospital

Data Source: Medical record review

Sample Size: Preintervention (n=988) Postintervention (n=870)

Age Range: Not specified