HEALTH & COST IMPACT OF MATERNAL CHILD ADVOCATE SERVICES

由护士和社区居民组成的团队进行的家访 母婴健康倡导者(MCHA)可以提供有效和 对文化敏感的干预，以改善INTERN的健康结果。 城市母亲和婴儿。如果成功，这种创新的健康模式 提供护理服务将解决美国婴儿死亡率居高不下的问题 比专业护士的家访更具成本效益。这 125例母婴干预和125例对照的随机对照试验 将评估母婴健康结果和婴儿健康 REACH-Futures项目的成本，该项目为 护士-MCHA团队在婴儿死亡率高的低收入社区。 母亲是在产前或分娩后立即招募的，并且 服务提供到婴儿12个月大为止。这个 MCHA-护士团队方法基于世卫组织初级卫生保健模式 它在发展中国家被广泛使用，以方便获得 医疗保健。心理健康教育干预内容及培训 MCHA是基于一个相互关联的母亲、婴儿、 以及随着时间的推移相互作用的社会环境因素 母婴结局。雄厚的理论基础应该使 程序很容易在全国范围内复制。 与对照组相比，干预组的母亲 预计将获得更有利的母亲心理健康， 更好的应对技能，以及更高的产前和计划生育利用率 和预防性产后护理。干预组婴儿应注意 显示更优化的医疗保健利用率、良好的增长和 发展，更少的可预防的死亡，更少的虐待和 疏忽和更少的事故。尽管婴儿经历的可能不会更少 疾病，通过预防性保健和及时发现更早 治疗应该减少患病、住院的时间，因为 以及急诊护理的费用。因此，总体医疗保健 生命第一年的成本预计会更低 干预组婴幼儿明显多于对照组。 这一创新的医疗保健提供干预措施尚未得到广泛应用 在美国使用和评估，特别是在市中心的少数民族。如果 我们可以证明干预是有效的，并降低了成本 通过仔细的评估，我们的模式将被移植到其他 全国各地的市中心遗址。

Home visits by a team of nurses and community residents trained as Maternal Child Health Advocates (MCHAs) can provide effective and culturally sensitive intervention to improve health outcomes for inner. city mothers and infants. If successful, this innovative model of health care delivery would address the persistently high U.S. infant mortality rates more cost-effectively than professional nurses' home visits. This randomized trial of 125 intervention and 125 control infant-mother dyads will evaluate the maternal and infant health outcomes and infant health costs of REACH-Futures, a project that provides home visits by a nurse-MCHA team in a low income community with high infant mortality. Mothers are recruited prenatally or immediately after delivery, and services are provided until the infant is twelve months old. The MCHA-nurse team approach is based on the WHO Primary Health Care model which is used widely in developing countries to facilitate access to health care. The content of the intervention and the training of the MCHAs is based on an ecological model of interrelated maternal, infant, and social-environmental factors that interact over time to affect maternal and infant outcomes. A strong theoretical base should make the program readily replicable throughout the nation. Compared to the control group, mothers in the intervention group are predicted to attain more favorable maternal psychological well-being, better coping skills, and higher utilization of prenatal, family planning and preventive postpartum care. Infants in the intervention group should show more optimal health care utilization, favorable growth and development, fewer preventable mortalities, less instances of abuse and neglect, and fewer accidents. Although infants may not experience fewer illnesses, earlier recognition through preventive health care and prompt treatment should reduce the duration of illnesses, hospitalizations, as well as the cost of acute care visits. Consequently, overall health care costs in the first year of life are expected to be lower for the intervention infants than the control infants. This innovative health care delivery intervention has not been widely used and evaluated in the U.S., especially for inner city minorities. If we can demonstrate that the intervention is effective and lowers costs through a careful evaluation, our model would be transferred to other inner city sites throughout the nation.