Follow-up study of the impact of a rural preventive care outreach program on children's health and use of medical services.

Abstract

The present study is a follow-up of a previous evaluation of a rural pediatric preventive care outreach program in Appalachia, which showed that although program participants did not differ substantially from their matched controls on health outcomes, they did have significantly lower utilization rates for outpatient services. The purpose of this second study was to determine whether replication of the original study would yield similar results on a fresh sample of children and whether differences observed between study and control groups would hold firmThe need for more and better outcome data has become an increasingly important concern in the field of health services research.1' 2 Outcome evaluation is defined here as an assessment of the impact of a health care program on the health of individuals who use it and on their utilization of medical services.3'4 This paper presents the results of an attempt to assess the effects of participation in a rural preventive care outreach program on the health and medical care of infants and young children.During 1975 a study was made of a sample of children who had participated in the health outreach program using matched controls from another community in the same area.The results of this initial study, described elsewhere,5'6 showed that although program participants did not differ substantially from their matched controls with respect to health outcomes of the indicator diseases, they did have significantly lower utilization rates for outpatient services. This paper presents the results of a second health outcome and medical care utilization study conducted during the summer of 1977, two years after the first study. The purpose of this present study was to determine whether replication of the original study would yield similar results on a fresh sample of Program services, which are available in the home, are initiated within the child's first month of life and are terminated at age two years. These services, rendered in the home according to a predetermined schedule of seven visits, include nutritional counseling, parental education regarding the importance of appropriate immunizations, assessment of the child's growth and development, treatment of minor health problems (e.g., diaper rash), and referral to the attending physician of any major problems detected. Additional services include (where appropriate) assistance in applying for food stamps, aid for dependent children (AFDC) or other welfare services, and provision of psychological support to the parents.During the program's first year of operation, over 95 per cent of the eligible infants born at the hospital received its