Use of evidence-based models and factors influencing program directors of prenatal case management programs

Community-based prenatal case management (PCM) of medically or socially high-risk pregnant women is intended to improve birth outcomes. Research has shown that at least two models of PCM are effective, but research is lacking on which forces influence whether evidence-based models are used. Our study sought to identify which organizational and contextual factors correlate with use of evidence-based PCM models.

Data available from an ongoing national survey of PCM programs were analyzed. PCM program directors (n=43) self-reported on the type of PCM model used, the percent of practice considered evidence-based, and the extent to which their decisions are influenced by contextual factors. Twenty-two of the 43 program directors reported using a model, theory or research for their current PCM program. Significant positive bivariate correlations were found between the percent of practice reported as evidence-based and: (a) influence of state requirements for reimbursement (r=.42, p=.007); (b) what has been recently published in professional journals (r=.44, p=.004); and (c) science or research about prenatal home visiting (r=.30, p=.057). A significant difference was found in mean influence of staff/peer preferences among programs using a type of model or theory and programs that are not (p=0.055).

These findings imply that state policy is an important factor in the decision to use evidence-based models of PCM, research does influence practice, and staff and peer influences play a greater role in programs using models. Further investigation is needed to identify which state requirements encourage the use of evidence to design PCM programs.