Effects of a Medicaid home visiting perinatal program on infant injury

Background There is renewed interest in broader dissemination of home visiting programs through funding under the Affordable Care Act. The objective is to explain early findings suggesting that infants participating in the home-visiting Maternal and Infant Health Program have higher odds of injury than similar non-participants.

Methods The study population is all Medicaid eligible women who gave birth in 2009 and 2010, and their infants. We used statewide maternal and infant linked data covering the first year after birth, including Medicaid claims, vital records, and program participation. A quasi-experimental evaluation of the MIHP effectiveness was complemented with descriptive statistics and multiple logistic analyses.

Results Overall, infant MIHP participants had higher odds of having injury-related diagnostics during their first year of life. Over 53% of the injuries were superficial, skin injury, burns, unspecified or unclassified. Over 85% of the infants with injury-related visits had those visits in emergency departments (ED). Infants with at least one ED visit in their first year of life had over five time the odds (OR=5.2, p<0.01) to have injury-related diagnostics. Infants who received the appropriate number of well-child visits in the first year had higher odds of having injury-related diagnostics (OR=1.8, p<0.01).

Conclusions In line with some of the prior literature evaluating other home-visiting programs, we found that infants participating in MIHP had higher odds of injury-related visits. MIHP participants seemed to be more are more aware of their infants' injuries and more likely to take infants for treatment, although in most cases to EDs.