Association for Public Policy Analysis & Management

Motivation: Baltimore City experiences one of the highest infant mortality rates in the country. Although a large percentage of pregnant women in Baltimore are Medicaid recipients, they often do not take-up pregnancy and postpartum support services that are available with an appropriate referral. Particularly for high-risk pregnancies, this can lead to adverse birth outcomes. To begin accessing these services, Medicaid-eligible patients must have a prenatal risk assessment (PRA) form filled out by their provider. Without this form, women with high risk pregnancies may not be referred to services such as insurance assistance, WIC, home visits by social workers, and smoking cessation assistance.

Intervention: In collaboration with the Baltimore City Health Department (BCHD), the Johns Hopkins University Center for Communication Programs (CCP) and other partners in the B’more for Healthy Babies (BHB) initiative, a package of behavioral interventions was randomized across prenatal care practices in Baltimore. The set of interventions included the following components:

• Checklist: The PRA Checklist includes execution notes for the 3 steps required to successfully complete a PRA: talking points for speaking to a patient about the PRA, steps and specific filling number for the PRA, and fax number for faxing the PRA.
• Feedback: Three quarterly feedback reports were used to compare how many PRAs an office completed in comparison to offices like it. They provided a visual image (smiley face or exclamation point) to indicate whether the office was doing better or worse than its peers. Additionally, practices who had not submitted any PRAs in the previous year received a report indicating that they need to submit PRAs to appropriately serve their patients.
• Testimonials: Patient testimonials included quotes from mothers who had benefitted from services referred through the PRA. They highlighted stories of mothers and babies with positive health outcomes as a result of services like home visiting and cribs. Testimonials will be sent to all treatment offices via email at intervals of 1-2 months.
• Information: A website was developed which provides a quiz that allows clinics to see how many of the standard PRA procedures they are/are not following. The website also has a list of behaviorally informed best practices that we developed based on site visits and advice from BHB/BCHD.

Methodology: Data collection will occur between March- September 2018 with the primary outcome being the number of PRAs submitted by each practice. Cluster randomization is used to identify effects in 25 control clinics compared to 27 treatment clinics throughout the city.

Results: The results, available by September 2018, will show whether this combination of peer comparison and informational interventions can impact providers’ PRA submission rates, referral rates to prenatal and postpartum support services, and the rate of accepted services by Medicaid-eligible women.

Conclusion: The results of this experiment will determine whether social and informational efforts impact PRA take-up and increase support-service access for pregnant Medicaid-eligible women in Baltimore.