First-time versus Multigravida Outcomes from the Kentucky Health Access Nurturing Development Services (HANDS) Program

Home visitation programs are associated with reduced rates of low birth weight infants and decreased prevalence of preterm births among women at high risk for poor outcomes.  However, these programs traditionally only serve first-time parents. The Kentucky Health Access Nurturing Development Services (HANDS) program is a state-developed home visitation program for expectant and new at-risk parents. In 2011, the HANDS Program expanded to serve women who were not first-time mothers (multigravida). As part of this expansion, an unanswered question is whether multigravidas benefit from home visitation services as much as first-time families do. This presentation will compare the outcomes of first-time mothers receiving home visiting services to multigravidas, specifically examining maternal and child health outcomes of receiving adequate prenatal care, maternal complications during delivery, low birth weight, preterm deliveries, and NICU admissions. HANDS administrative data and live birth certificate records from will be used. We will analyze approximately 4,000 mothers who were referred to HANDS between October 1, 2011 and September 30, 2014 and received at least one prenatal home visit. Chi-square statistics and conditional logistic regression models will be used to evaluate the impact of HANDS on MCH outcomes. We expect to show that the HANDS program produces favorable outcomes for all families, not just first-time mothers, resulting in significant improvements in maternal and health outcomes among high-risk women.  If the outcomes for multigravida women are equal to that of first-time mothers, home visiting programs may need to revisit the restriction to serve only first-time parents.