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Primary Submission Category: Interventions/Programs
Mixed-methods evaluation of a Maternal Home program in a safety-net healthcare system in New York City
Authors: Rachel Massar, Lorraine Kwok, Renata Howland, Lorna Johnson, Sarah Sisco, Wendy Wilcox, Kayla Fennelly, John Billings, Carolyn Berry,
Presenting Author: Rachel Massar*
NYC Health + Hospitals, the largest safety-net healthcare system in the U.S., launched the Maternal Home program in 2019 to provide pregnant and postpartum patients with support, education, and linkages to services to reduce maternal morbidity and mortality. We are conducting a mixed-methods implementation and outcome evaluation using interviews with program leadership, staff, providers, and patients; pre-post patient surveys; and New York State Medicaid claims data. Interviews are analyzed using rapid qualitative methods. Telephone surveys at baseline and ~6-weeks postpartum assess self-reported health, pre/postnatal depression, healthcare self-efficacy and engagement, parental stress and confidence, social support, social needs, connection to services, and clinic/program satisfaction. Medicaid claims (280 days pre-delivery to 1 year postpartum) compare demographic, clinical, and utilization patterns between participants and non-participants delivering at the same hospitals (non-risk-adjusted), with regression models testing group differences. Preliminary interview findings elucidate implementation barriers and facilitators, perceived benefits, and areas for improvement. Survey results are forthcoming. Consistent with enrollment goals, claims analysis showed participants were more likely to be older/younger, multiparous, have multiple chronic conditions, documented social needs (14% vs. 11%), and higher rates of gestational diabetes, pre-existing hypertension/diabetes, and mental health conditions, more prenatal visits (12.8 vs. 10.9), higher continuity of care (77% vs. 70%), and more emergency department visits (2.3 vs. 1.7) during pregnancy. Participants were more likely to attend a postpartum visit by 84 days (77% vs. 69%) and obtain outpatient mental health treatment (12.4% vs. 8.3%). Findings provide early evidence on how a maternal program can engage high-risk patients and enhance use of services, informing design and implementation of similar programs.