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Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services., Author(s): Lee Anne Roman [sup.1] , Jennifer E. Raffo [sup.2] , Katherine Dertz [sup.3] , Bonita Agee [sup.4] , Denise Evans [sup.4] , Katherine Penninga [sup.5] , Tiffany Pierce [sup.5] [...]

To compare infant injuries in the first year of life between Maternal Infant Health Program (MIHP) participants and matched comparison groups. The population was the cohort of Medicaid-insured singleton infants born in 2011 in Michigan who had continuous Medicaid insurance and survived the first year after birth (N = 51,078). Propensity score matching was used to compare participants in MIHP to matched comparison groups from among the nonparticipants. Injury episodes were defined based on Medicaid claims in the first year of life. Matched comparisons were performed using McNemar, Bowker, and Wilcoxon signed rank tests to assess the effects of program participation on infant injuries. Infants of MIHP participants were more likely to have injury episodes (11.7 vs. 10.4 %, p < 0.01) and a higher rate of episodes (126.9/1,000 infants vs. 109.6/1,000) compared to matched nonparticipants. Infants of MIHP participants were more likely to have superficial injuries (4.9 vs. 3.9 %, p < 0.01) and a higher rate of episodes related to superficial injuries (49.7/1,000 vs. 39.6/1,000), which mainly accounted for the difference in injury visits between groups. Similar results were found among those enrolled and risk-screened in the program by the 2nd pregnancy trimester and who received a dosage of at least three additional MIHP contacts when compared to matched nonparticipants. MIHP participants did not experience reductions in infant injuries in the first year of life compared to matched nonparticipants. Possible explanations may include increased health-seeking behavior of the mothers participating in MIHP or improved recognition of infant injuries that warrant medical attention., Author(s): Cristian I. Meghea[sup.1] [sup.2] [sup.3] , Zhiying You[sup.1] , Lee Anne Roman[sup.2] [sup.4] Author Affiliations: (1) Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, [...]

Objectives: Evaluating population health initiatives at the community level necessitates valid counterfactual communities, which includes having similar population composition, health care access, and health determinants. Estimating appropriate county counterfactuals is challenging in states with large intercounty variation. We describe an application of K -means cluster analysis for determining county-level counterfactuals in an evaluation of an intervention, a county perinatal system of care for Medicaid-insured pregnant women. Methods: We described counties by using indicators from the American Community Survey, Area Health Resources Files, University of Wisconsin Population Health Institute County Health Rankings, and vital records for Michigan Medicaid-insured births for 2009, the year the intervention began (or the closest available year). We ran analyses of 1000 iterations with random starting cluster values for each of a range of number of clusters from 3 to 10 with commonly used variability and reliability measures to identify the optimal number of clusters. Results: The use of unstandardized features resulted in the grouping of 1 county with the intervention county in all solutions for all iterations and the frequent grouping of 2 additional counties with the intervention county. Standardized features led to no solution, and other distance measures gave mixed results. However, no county was ideal for all subpopulation analyses. Practice Implications: Although the K -means method was successful at identifying comparison counties, differences between the intervention county and comparison counties remained. This limitation may be specific to the intervention county and the constraints of a within-state study. This method could be more useful when applied to other counties in and outside Michigan. [ABSTRACT FROM AUTHOR]