Impact of Healthy Start Home Visiting Model on Reduction Perinatal Health Disparities in Allegheny County, PA: Evaluation of Five-Year Major Perinatal Outcomes

The Pittsburgh/Allegheny County(AC) Healthy Start(HS) program is designed as an intensive community-based effort to eliminate perinatal health disparities. Since beginning operation in 1991, HS continues to address the significant disparities, especially in African-Americans(AA), that exist with regard to infant mortality, incidence of low weight births, preterm delivery, access to early prenatal care and the need for on-going community involvement. The HS home visiting model includes a multidisciplinary team utilizing the interventions of outreach and recruitment, case management, interconception care, health education, and depression screening and referral. The objective of this project, as a part of ongoing evaluation activities, was to assess 5 year(2003-2007) impact on major perinatal outcomes in AC. The primary outcome variables assessed were infant mortality, low birth weight, and first trimester prenatal care. Given the racial demographics of HS participants (88.0% African-American, N= 6509) and the persistent racial disparities in perinatal health, the general population and AAs in AC were also used as a comparison groups. The infant mortality rate in HS participants (4.2 per 1,000 live births) was significantly lower than all races in AC (7.7 per 1,000 live births) and AAs in AC (18.4 per 1,000 live births). The percent of low birth weight births for HSI participants (10.2%[95%CI: 8.68, 11.76]) was lower than AAs in AC (14.1%[95%CI: 12.46, 15.56]), but higher than all races in AC (8.4%[95%CI: 8.03, 8.72]). The percent entering prenatal care during the first trimester was higher for HSI participants (90.9%[95%CI: 89.63, 92.17]), compared to all races in AC (87.1%[95%CI: 85.29., 88.94]) and AAs in AC (78.3%[95%CI: 75.94, 80.66]). The results of this analysis provide further evidence that the Healthy Start home visiting model is an effective method of reducing infant mortality rates, increasing access to care for mothers and infants, and ultimately, decreasing the gap in racial health disparities.