HEALTH & COST IMPACT OF MATERNAL CHILD ADVOCATE SERVICES

一组护士和社区居民进行家访， 母婴健康倡导者（MCHAs）可以提供有效的， 采取文化敏感的干预措施，改善内地居民的健康状况。 城市母亲和婴儿 如果成功，这种创新的健康模式 医疗服务将解决美国婴儿死亡率居高不下的问题 比专业护士家访更具成本效益。 这 125例干预组和125例对照组母婴配对的随机试验 将评估母婴健康结果和婴儿健康 REACH-Futures的费用，这是一个提供家庭访问的项目， 在一个低收入社区，婴儿死亡率很高。 母亲在产前或分娩后立即招募， 服务提供至婴儿满12个月。 的 MCHA-护士团队方法基于世卫组织初级卫生保健模式 在发展中国家广泛使用， 保健 干预的内容和培训的 MCHAs基于相互关联的孕产妇，婴儿， 和社会环境因素，随着时间的推移， 产妇和婴儿的结果。 一个坚实的理论基础应该使 该计划在全国范围内易于复制。 与对照组相比，干预组的母亲 预计会获得更好的母亲心理健康， 更好的应对技能，产前计划生育的利用率更高 和预防性产后护理。 干预组的婴儿应 显示出更佳的卫生保健利用率、有利的增长， 发展、可预防的死亡率减少、虐待事件减少， 忽视，事故更少。 虽然婴儿可能不会经历更少的 疾病，通过预防性保健和及时 治疗应减少疾病的持续时间，住院时间， 以及急诊的费用。 因此，整体医疗保健 预计第一年的成本将较低， 干预组的婴儿比对照组的婴儿。 这种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，尤其是对于市中心的少数民族来说。 如果 我们可以证明干预是有效的， 通过仔细的评估，我们的模型将被转移到其他 在全国范围内的内城遗址。

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.