295: “Safe Start”: A community health worker program that improves perinatal outcomes in high risk women

Abstract

Prevalence of chronic conditions (e.g., obesity, hypertension, diabetes, depression, substance use disorder) in pregnant women is increasing, with higher rates among low-income and minority populations. We assessed the effectiveness of a community health worker (CHW) program to improve perinatal outcomes in low- income pregnant women with chronic conditions. Between March 2015 and February 2018, we implemented and evaluated “Safe Start”, a CHW program representing a partnership between an inner city, hospital-based prenatal clinic, a community-based organization, and a Medicaid managed care insurer. Safe Start CHWs engage in patient navigation and systematic case review with health care providers and insurers. Patient eligibility criteria included: pregnant <34 weeks; presence of obesity, hypertension, diabetes, depression and/or a substance use disorder; and evidence of >= 1 missed appointment. Multivariable logistic and poisson regression were used to compare women enrolled in the program (n=208) with women who were eligible to participate but did not enroll (n=226), controlling for potential confounders. Outcomes assessed included: prenatal care adequacy, preterm birth, cesarean delivery, NICU admission, neonatal abstinence syndrome, postpartum visit attendance, breast-feeding and contraception use. Safe Start program participants were significantly more likely to be African American and report substance use than women in the comparison group (Table 1). Relative to the comparison group, Safe Start participants had 68%, 49%, and 40% lower odds of inadequate prenatal care (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.20, 0.49), inpatient admission (OR 0.51; CI 0.30, 0.87), and emergency room/triage visits OR 0.60; CI 0.40, 0.90) during pregnancy, respectively (Table 2). Additionally, Safe Start participants had higher odds of attending their postpartum visit (OR 1.72; CI 1.18, 2.59) and of postpartum contraception use (OR 2.09; CI 1.27,3.43). Participation in Safe Start improves patient engagement in care and reduces antepartum admissions and triage visits thereby mitigating risks associated with chronic conditions during pregnancy. Future studies should evaluate the cost effectiveness of this program as well as its impact on the health and well-being of women and their families.View Large Image Figure ViewerDownload Hi-res image Download (PPT)