Increasing Utilization of Home Visiting Programs Among Individuals Who Are Publicly Insured During the Perinatal Period.

OBJECTIVE: To evaluate the effect of enhanced outreach efforts and referral processes on patient engagement with public health home visiting programs (HVPs) during the perinatal period among those who are publicly insured. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: Maternal health disparities exist among patients who are publicly insured and at greater risk for severe maternal morbidity and birth and neonatal complications. HVPs are associated with improved maternal and infant health outcomes. Despite these benefits, patient engagement in these programs was low at an obstetric clinic in San Francisco. This finding revealed the need for process improvements in patient outreach and referral coordination. PARTICIPANTS: Five clinic team members and 20 individuals who are publicly insured and seen for prenatal and postpartum care. METHODS: The intervention involved a three-pronged approach with (a) staff training, (b) new patient education materials, and (c) an updated referral workflow. Measurements included staff knowledge of program benefits and intent to refer, percentage of patients referred, referral acceptance rate, and program enrollment. RESULTS: All five team members received training and the new educational materials and workflow; 80% (n = 4) reported a high level of understanding of program benefits, and 100% (n = 5) stated a high intent to refer patients. Of participating patients, 95% (n = 19) were offered referrals. Of those presented with referrals, 58% (n = 11) accepted a referral. At 2 months of intervention, 20% of participants (n = 4) were enrolled in an HVP, an increase from the preintervention enrollment rate of 8%. CONCLUSION: This evidence-based quality improvement project resulted in effective team member engagement in HVP outreach and referral processes and increased program utilization during the perinatal period by patients who are publicly insured.