Improving EPSDT Use: Development and Application of a Practice‐Based Model for Public Health Nursing Research

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Section: Overviewmentioning

confidence: 99%

Diversity in the Rural Poor: Differences between Households with and without Telephones

Selby-Harrington

Tesh

Donat

et al. 1995

“…The Public Health Nursing Practice-Based Research Model (Selby, Riportella-Muller, Sorenson, & Walters, 1989) assisted the investigators with identifying factors related to less-than-adequate preventive services among infants from low-income families; planning an innovation to accommodate the characteristics of the target population, facilitate access to care, and reinforce continuity of care; and designing the evaluation methods for assessing the intervention's effectiveness and cost-effectiveness ( Fig. 1).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…Adequate child preventive services. An effective intervention, according to Selby et al (1989), is an intervention that achieves the desired impact, in this case adequate child preventive services. There were two measures of adequate child preventive services: completion of the number of comprehensive child health clinic visits within three months of the schedule recommended by the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT); and completion of childhood immunization within three months of the schedule recommended by the Centers for Disease Control.…”

Section: Operational Definitionsmentioning

confidence: 99%

Case Management and Preventive Services Among Infants from Low‐Income Families

Erkel

Morgan

Staples

et al. 1994

To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequivalent control group with covariate measures design was employed in a sample of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) provided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child health care was characterized by fragmentation of services. Case management was segregated from preventive services, and multiple PHNs delivered care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiveness (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate immunization was 8% less in continuous care ($359) than in the fragmented approach ($386), although the difference in rates of adequate immunization was nonsignificant (experimental group, 64%; control group, 60%). These findings suggest that continuous PHN care with integrated case management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-management approach.

“…In accordance with the model, phase I of the Healthy Kids Project focused on enhancing the enabling factors of availability and accessibility of services, specifically by recruiting private physicians to provide EPSDT screenings. A detailed description of how the PRE-CEDE model guided the project as a whole is provided by Selby et al (1989Selby et al ( , 1990.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…In this project, the majority of the development costs of $4000 related to designing and testing the pamphlet. As noted above, the pamphlet was planned in accordance with key concepts from the PRECEDE model, and was tested rigorously for its appeal to a target population of mothers, mostly nonwhite, of EPSDT-eligible children (Selby et al, 1989(Selby et al, , 1990. If revision is undertaken by others, development costs can be reduced substantially by using the tested pamphlet from this project as a model.…”

Section: Modifying the Intervention Packetmentioning

confidence: 99%

Easing the Burden on Health Departments: A Cost‐Effective Method for Public Health Nurses to Increase Private Sector Participation in the Early and Periodic Screening, Diagnosis, and Treatment Program

Selby-Harrington

Riportella-Muller

1993

Self Cite

Federal legislation requires states to increase use of the early and periodic screening, diagnosis, and treatment (EPSDT) program. The program provides comprehensive health services to children from low-income families on Medicaid and has been shown to improve health and reduce health care costs. Health departments and public health nurses (PHNs) bear a major burden conducting EPSDT screenings because many private physicians choose not to provide these services. Given scarce resources, health departments alone may be unable to meet the mandate for increased EPSDT services. Thus PHNs concerned about children's access to health care may have to encourage provision of EPSDT through the private sector. This project, phase I of the federally funded Healthy Kids Project to increase EPSDT use in rural areas of North Carolina, established the cost-effectiveness of a mailed intervention to recruit private physicians to do EPSDT screens that exceeded the capacity of health departments. The intervention, consisting of a personal letter, journal article, and pamphlet, was sent to all 73 primary care physicians in six rural counties. Before the mailing, 15 (21%) of the 73 physicians were willing to provide EPSDT screenings; after the mailing the number rose to 25 (34%). The one-time cost to recruit each provider was less than the estimated annual cost savings associated with each child in the EPSDT program.