Medicaid home-visitation program linked to reduced infant mortality

1. Participation in a Medicaid-based, home-visitation program offering supplemental regular prenatal and infant care in Michigan was associated with reduced odds of infant mortality within the first year of life for all races/ethnicities.

2. Enrollment in the first or second trimester and greater participation was associated with a further reduced risk of infant death in all races/ethnicities.

Evidence Rating Level: 3 (Average)

Study Rundown: Infant mortality continues to be a significant public health issue in the United States, especially among lower socioeconomic and minority racial/ethnic groups. Enhanced prenatal and postnatal care (EPC) programs have been established in order to educate and reduce the risk of adverse health outcomes in families who are Medicaid-insured. Authors of the current study sought to examine the benefits of the statewide EPC program in Michigan and its effects on infant mortality. The Michigan Maternal Infant Health Program (MIHP) is available to all Medicaid-eligible pregnant woman and their infants, and provides supplemental regular prenatal and infant care through home visitation by registered nurses and licensed social workers. Results displayed that the MIHP participants of all races/ethnicities had reduced odds of infant death within the first year of life. Early enrollment and greater participation in the program further reduced odds of death within all races. These study findings may be limited as MIHP dosage dimensions (duration of enrollment, etc.) were not measured, infant deaths may have been lost if families moved out of the state, and MIHP effect estimations may be imprecise. However, the results may urge Michigan health care providers to encourage early participation in MIHP and other providers around the country to investigate Medicaid-based, home-visitation programs in their own areas.

Click to read the study, published today in Pediatrics

Relevant Reading: The role of preschool home-visiting programs in improving children’s developmental and health outcomes

In-Depth [case-control study]: A total of 229 633 Medicaid-insured, singleton births from January 2009 through December 2012 in Michigan were included in this study. Mothers who participated in the MIHP were matched to mothers in the control group who were Medicaid-insured but did not participate in MIHP. Participants were matched based on age, marital status, race/ethnicity, county of residence, smoking status during pregnancy, previous birth history, and socioeconomic status. There were no significant differences in baseline characteristics between participants of MIHP and non-participants. All infants [all races: OR 0.73 (95% CI 0.63-0.84), black: OR 0.71 (95% CI 0.58-0.87), nonblack: OR 0.74 (0.61-0.91)] who had any contact with the MIHP program had reduced odds of death within the first year of life. Participants who were enrolled in the first or second trimester and had >3 contacts with the program saw even greater reduced odds [all races: OR 0.70 (95% CI 0.58-0.85), black: OR 0.73 (95% CI 0.56-0.96), nonblack: OR 0.67 (95% CI 0.50-0.89)]. Based upon the results, it was estimated that 28% of potential infant deaths may be prevented with MIHP participation, and 2 deaths may be prevented for each 1000 singleton, Medicaid-insured births.

Image: PD

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