PEDIATRICS Vol. 101 No. 6 June 1998, pp. 999-1005

Utilization of Well-child Care Services for African-American Infants in a Low-income Community: Results of a Randomized, Controlled Case Management/Home Visitation Intervention

Received Jul 31, 1997; accepted Nov 17, 1997.

Mark A. Schuster^*, , David L. Wood^{*, §}, Naihua Duan^*, Rebecca M. Mazel^*, Cathy D. Sherbourne^*, and Neal Halfon^{*, ,}

From ^* RAND, Santa Monica, California;  the Department of Pediatrics, School of Medicine, and  the School of Public Health, University of California, Los Angeles, California; and ^§ Shriners Hospitals for Children, Tampa, Florida.

Objective.  To evaluate a case management/home visitation intervention to improve access to and utilization of well-child care (WCC) visits.

Study Design.  Randomized, controlled trial with baseline and follow-up interview surveys. Mothers and infants in the intervention group were assigned to a case manager who made at least four home visits during the infant's first year of life. In addition, the case managers contacted clients by telephone and mail to see if they had kept their WCC appointments and to follow up on other issues.

Sample and Data Collection.  A population-based random sample of African-American mothers of newborns from South Central Los Angeles: 185 mothers in the intervention group and 180 in the control group completed both interview surveys. The principal outcome variable was number of WCC visits. Additional outcome variables included the child's type of insurance, the number of months with insurance coverage during the first year of life, age when first enrolled in Medi-Cal, age at the first WCC visit, usual source of WCC, travel time to the usual source of care, whether the child had a regular provider, and whether the child ever needed care but did not get it.

Results.  There was little change in the overall distribution of number of WCC visits during the first year of life. Comparisons of the cumulative numbers of visits for each possible cutoff showed that children in the intervention group were more likely than children in the control group to have at least four visits (81% vs 70%). Because this split was identified empirically rather than through an antecedent hypothesis, we conducted a Smirnov test to account for multiple comparisons. This test showed a reduced level of significance. Other outcome variables did not show significant differences for the control and intervention groups.

Conclusions.  In light of the high expense of this intervention, our evaluation shows that our moderate- intensity case management and home visitation program is not an effective way to increase the number of WCC visits.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. J. Hambidge, S. L. Phibbs, V. Chandramouli, D. Fairclough, and J. F. Steiner A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population Pediatrics, August 1, 2009; 124(2): 455 - 464. [Abstract] [Full Text] [PDF]

				A. G. Fiks, K. F. Hunter, A. R. Localio, R. W. Grundmeier, and E. A. Alessandrini Impact of Immunization at Sick Visits on Well-Child Care Pediatrics, May 1, 2008; 121(5): 898 - 905. [Abstract] [Full Text] [PDF]

				S. J. Hambidge, A. J. Davidson, S. L. Phibbs, V. Chandramouli, G. Zerbe, C. W. LeBaron, and J. F. Steiner Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population: A Cluster Randomized Controlled Trial Arch Pediatr Adolesc Med, February 1, 2004; 158(2): 162 - 169. [Abstract] [Full Text] [PDF]