Enhancing postpartum care access: associations between home visiting participation and postpartum visit attendance using a Quasi-Experimental study design.

backgroundThe Early Intervention Parenting Partnerships (EIPP) program is a multidisciplinary home visiting program that provides health screenings, education, counseling, and service coordination to expectant parents and families who experience pregnancy-related risk factors such as inadequate prenatal care or social risk factors including insufficient basic resources, depression, or violence in the home. This study examined whether EIPP was associated with receipt of postpartum visits in the first 90 days post-birth, overall and stratified by adequacy of prenatal care.

methodsEIPP participants (n = 611) who enrolled prenatally from 2013 to 2017 were matched to a comparison group of families identified from birth certificates using coarsened exact matching. Study outcomes included receipt of postpartum visits before 21 days, 21 to 60 days, and 61 to 90 days post-birth based on healthcare claims codes using a definition of postpartum care based on Healthcare Effectiveness Data and Information Set (HEDIS) and an expanded definition that included additional codes used by providers to document postpartum care including visits related to contraception, feeding, and depression screening. Weighted regression models assessed differences in the odds of postpartum visit receipt (using HEDIS and expanded definitions) between the EIPP and comparison groups, with subsequent models examining adequacy of prenatal care as a moderator.

resultsUsing the expanded definition, EIPP participants had 51% greater odds of receiving postpartum care 21 to 60 days (aOR = 1.51, 95% CI [1.25, 1.83]) and 38% greater odds 61 to 90 days (aOR = 1.38, 95% CI [1.11, 1.71]) post-birth relative to the comparison group. The adjusted odds ratio of the association between EIPP and receipt of visits 21 to 60 days post-birth was greater among participants who received less than adequate (vs. adequate) prenatal care (aOR = 2.20, 95% CI [1.49, 3.25] less than adequate; aOR = 1.28, 95% CI [1.03, 1.59] adequate). Postpartum care receipt did not vary using the HEDIS definition.

conclusionsHome visiting programs such as EIPP that address barriers to healthcare access may increase uptake of postpartum visits. This support may be most important for people who struggle to connect to healthcare systems and are a critical part of a system that promotes health equity and positive birth outcomes.