Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Concurrent Infant/Mother Checkups

Intervention Description: The Mother-Infant dyad postpartum primary care program was part of Ohio Gestational Diabetes Postpartum Care Quality Improvement Collaborative, a multi-year initiative sponsored by the Ohio Departments of Health and Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center. The Dyad program evaluation was conducted in the context of a quality improvement (QI) initiative aimed at increasing postpartum type 2 gestational diabetes (T2DM) screenings during the 4–12 week postpartum period and also increasing postpartum visit attendance with a prenatal provider. Women were eligible for the Dyad program if they lived in central Ohio and had a diagnosis of gestational diabetes mellitus (GDM) during the most recent pregnancy or condition suggesting previous undiagnosed GDM. Following delivery, Dyad program appointments occurred concurrent with the infant’s well-check visits and allowed mothers to access comprehensive postpartum care services including but not limited to postnatal screening for T2DM, health and wellness education, breastfeeding support, and referrals to specialty services if indicated. An on-site patient navigator contacted mothers by phone in advance of the visit to address barriers to care including transportation and childcare. Reminders were also sent via phone and electronic health record (EHR) patient portal to con- firm attendance. The Dyad program facilitated postpartum obstetrics to primary care hand off to improve longitudinal care engagement for disease management and prevention.

Intervention Results: Women who participated in the Dyad program were more likely to complete a postpartum visit and receive type 2 diabetes mellitus (T2DM) screenings than women who did not participate. In addition, fewer women who participated in the program experienced new T2DM diagnoses (17%) than those in the comparison group (29%), yet a greater proportion of Dyad program participants experienced new predia- betes diagnoses (12%, p<.001) than those in the com- parison group (6%, p<.001).

Conclusion: The Mother-Infant Dyad postpartum primary care program improved type 2 diabetes mellitus screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program partici- pants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.

Study Design: Analysis of patient surveys, claims data, and administrative records

Setting: Midwestern academic medical center internal medicine and pediatrics primary care clinic

Population of Focus: Postpartum patients with a previous diagnosis of gestational diabetes mellitus

Sample Size: 75 mother-infant dyads

Age Range: Mean age 30.75

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Patient Navigation (Assistance), Outreach (Provider), Enrollment Assistance

Intervention Description: Community Health Centers (CHCs) serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Specialized staff, called enrollment assistants, can help to determine insurance eligibility and/or guide patients through application processes, including assistance with completing application forms, understanding requirements, and providing appropriate documentation.

Intervention Results: Enrollment assistants are valuable resources, and CHCs are effective at helping patients with public health insurance. The enrollment assistants helped families understand the process and avoid mistakes and delays while patients valued their advice and their pragmatic, hands-on application assistance.

Conclusion: Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Study Design: Observational cross-case comparison

Setting: Community (Community-health centers in Oregon)

Population of Focus: Practice members (e.g., managers, clinical and non-clinical staff, enrollment assistants) and families using community health centers

Data Source: Observations and interviews

Sample Size: 4 Community Health Centers (CHCs) in Oregon; 26 practice members; 18 adult family members who had at least one pediatric patient

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Patient Reminder/Invitation, Participation Incentives, Shortened Appointment Interval

Intervention Description: Women were randomized to receive 3–4 and 6–8 weeks postpartum appointments and were followed for 18 months. Study participants were recruited from the VCUMC in-patient postpartum unit by using Electronic Health Records (EHR) to monitor deliveries. Eligible women were contacted within 48 h of delivery and informed about the study. Women who agreed to participate were asked to sign the informed consent form, which authorized research staff to access participants' EHR to enhance tracking of postpartum visit attendance. Study participants were interviewed in person at baseline (within 48 h of delivery) and at the postpartum visit. Participants were compensated $25 for completing the baseline interviews and $30 for completing the postpartum interviews. Follow-up assessments were administered via telephone at 3, 6, 9, 12, and 18-months post-delivery to evaluate secondary outcomes including contraceptive use, infant feeding practices, pregnancy status, stress and social support, and socio-demographic and medical information. Each of the follow-up assessments lasted approximately 10–15 min, and participants were compensated $10 per follow-up assessment. To reduce loss to follow-up, participants' contact information, as well as contact information for at least three persons who would know the participants' whereabouts and could get messages to them, were collected from the patients. To compensate study subjects for their participation and encourage follow-up assessment compliance, thank you letters along with appointment reminders and additional $10 checks were mailed to each participant monthly. This was especially important for hard-to-track women who did not have working phone numbers and did not return for postpartum visits. Additionally, per study protocol, participants received appointment reminder SMS text messages and/or emails 1 day before their scheduled follow-up phone interviews. If participants could not be reached, up to four attempts were made to contact the participant on different days and times of the day, in an effort to schedule the interviews.

Intervention Results: The overall postpartum visit adherence rate was generally high in the study. However, the adherence rate was observed to be relatively lower in the 3–4 weeks group (71%) compared to the 6–8 weeks group (90%). One reason that may explain this finding is that participants may have been more familiar with the traditional 6–8 weeks postpartum visit and thus, may have had some inertia or difficulty in attending a 3–4 week postpartum visit. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3–4 weeks group: 88.0%; 6–8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3–4 (70.5%) and 6–8 (90.0%) week postpartum groups.

Conclusion: In this trial, we successfully maintained high completion rates throughout the course of the study. This is important given that the study population included hard-to-track women who typically do not return for postpartum visits [12]. Due to economic challenges, underserved women may not have permanent addresses or phone numbers. By utilizing a participant tracking form, we obtained contact information from at least three persons who generally knew the participants' whereabouts and could contact them. This provided multiple avenues for reaching participants and enhanced retention. Additionally, monthly communication and incentives provided the opportunity to maintain participant engagement.

Study Design: Prospective, open-label randomized control trial

Setting: Virginia Commonwealth University Medical Center

Sample Size: 364 women

Age Range: 18-43

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): Patient Navigation (Assistance), Shortened Appointment Interval

Intervention Description: Participants were randomized with 1:1 allocation to 2 arms. In the control arm, participants were instructed to schedule their routine visit at 6 weeks after delivery (defined as 29–56 days after delivery). Participants in the intervention arm were instructed to schedule a visit at 2 weeks after delivery (8–28 days after delivery) in addition to 6 weeks after delivery.

Intervention Results: The attendance at 1 or more postpartum visits was not significantly different among the control and intervention arms (58% vs 70%; P=.065). The 2-week visit had an attendance rate of 41% (51 of 125), and the 6-week visit had an attendance rate of 60% (151 of 250). After adjusting for confounders, significant predictors of postpartum visit nonattendance included younger age, multiparity, and being a patient from the high-risk obstetrical clinic. The rate of emergency department visits was similar between the control and intervention arms (8% vs 6%; P=.635). However, more patients in the control arm come to the clinic for nonroutine visits (30% vs 16%; P=.010). In response to a patient satisfaction survey on the optimal timing of the postpartum visit, most respondents (59%) would have preferred both the 2- and 6-week visits.

Conclusion: The addition of a 2-week postpartum visit to the 6-week postpartum visit did not increase the likelihood of attendance of patients in a routine visit but did decrease the number of urgent clinic visits.

Study Design: Parallel, randomized, nonblinded trial

Setting: Publicly insured clinic in a tertiary academic medical center

Population of Focus: Postpartum patients

Sample Size: 250

Age Range: ≥18

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

Intervention Description: The intervention in the study involved the implementation of patient navigators (PNs) in a pediatric primary care practice. The PNs were bachelor's-level staff trained to assist with patient and family needs, such as referrals to Medicaid-sponsored transportation services, assisting parents in filling out challenging paperwork, and coordinating appointments. Providers referred patients to PNs via an order in the electronic medical record (EMR) or by paging the on-call PN. The PNs received training by social work staff, and biweekly, they met with clinic social work and nursing staff to review cases and iteratively learn from their experiences. The PNs' role was formalized in the fall of 2014 to focus on assisting families with adherence to follow-up visits and subspecialty referrals, accessing developmental services, overcoming transportation barriers, and transitioning to adult care. The study also distinguished PNs from both resource specialists, who handled concrete resource needs, and social work staff, who focused on more complex psychosocial concerns,.

Intervention Results: PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals. The most common reasons for referral were assistance overcoming barriers to care (46%), developmental concerns (38%), and adherence/care coordination concerns (14%). Significant predictors of referral were younger age, medical complexity, public insurance, male sex, and higher rates of no-show to visits in primary or subspecialist care. The majority of referrals were resolved. The referrals for process-oriented needs were significantly more successful than those for other concerns.

Conclusion: Yes, the study reports several statistically significant findings. For example, the study found that successful referral to patient navigators was significantly associated with private payor, Asian American ethnicity, medical complexity, younger age, type of patient navigator referral, provider type referring to patient navigators, longer time spent on referral, fewer no-shows, and more completed visits. Additionally, the study identified factors significantly associated with successful referrals to patient navigators on multivariate analysis, such as the reason for referral. These findings indicate the presence of statistically significant associations within the study.

Study Design: The study design is a retrospective analysis conducted in a clinical setting. It involves tracking the outcomes of patient navigator referrals and analyzing the factors associated with successful referrals. The study also includes demographic data on both referred and nonreferred clinic patients, indicating a retrospective observational study design.

Setting: The study was conducted at one large hospital-based pediatric primary care clinic serving more than 16,000 patients who are predominantly publicly insured and nonwhite. The clinic is located in an urban area.

Population of Focus: The target audience for the study is healthcare providers, administrators, and researchers who are interested in improving access to care for vulnerable populations, particularly children with medical complexity, low health literacy, or limited English proficiency. The study may also be of interest to patient navigators and other healthcare professionals who work with underserved populations.

Sample Size: The sample size for the study is not explicitly mentioned in the provided excerpts. However, the study mentions a subset of 1109 patient navigator referrals that were assessed for predictors of a successful referral. This subset represents a portion of the overall sample size used in the study.

Age Range: The age group discussed in the article varies, but it includes infants, toddlers, school-age children, and adolescents. The study found that referral to patient navigators was more likely for children under 3 years of age.