Using Evidence for Prenatal Case Management Structure
Project Number: R40 MC 05472-02 Project Date: 09/01/2005 Grantee: University of Illinois Chicago School of Public Health Department/Center: Community Health Sciences
Michele L. Issel Ph.D., Clinical Associate Professor, University of Illinois Chicago School of Public Health Community Health Sciences, 1603 West Taylor Street, MC 923 Chicago, IL 60612-4394 issel@uic.edu
Abstract
Prenatal case management (PCM) is a community-based, health service provided to medically and socially high risk pregnant women. Twenty years of data from three longitudinal clinical trials show that PCM provided by registered nurses (RNs) has better outcomes for pregnant and parenting women than programs using lay para-professionals. Yet, the evidence based (EB) professional model is not universally implemented and program structure varies. The purpose of this research is to understand barriers to the use of the EB professional model so that more effective adoption of interventions can be developed.
The aims of this study are to: (1) Characterize the types of existing PCM program models based on staff mix and extent to which it is an EB professional nursing PCM program model; (2) Identify the relationship of organizational and program internal environment to use of the EB professional nursing PCM model; (3) Identify the relationship of community, organizational, program internal environment, and program model to CM practice patterns; and (4) Identify the relationship of PCM program model and practice patterns to program outcomes, given community, organizational, and program internal environment. These aims are derived from four preliminary studies and a multi-level conceptual model. Study Aim 2 encompasses specific hypotheses predicting use of the EB program model.
A survey methodology is used with a multi-stage sample design with probabilities proportionate to number of PCM programs per state, yielding 10 states from which a random sample of 30 programs are selected per state. Survey data are collected from 250 PCM program directors and 1250 personnel involved in directly providing PCM to clients. Instruments include scales with demonstrated reliability with PCM personnel. Intervention data are also collected from case managers. Data are aggregated to the program level for analyses, and linked with community data from the Area Resource File and state vital statistics. Descriptive statistics are used to derive types of PCM program models and address hypotheses regarding contextual influences on the program model. Multiple regression, MANCOVA, and hierarchical linear modeling analyses are planned for Study Aims 3 and 4.
Publications
Listed is descending order by year published.
Issel LM, Forrestal S, Wheatley R, Slaughter J, Schultz A. (2008, Feb. 5). Surveying Hard to Reach Programs: Identifying the Population of Medicaid Prenatal Case Management Programs. Maternal and Child Health Journal, Epub ahead of print.
