RAND Study Identifies Ways to Cut Deaths and Illness Among Mothers and Young Children in Allegheny County, Pennsylvania

The illness and death rates of mothers and their young children in Allegheny County, Pennsylvania, can be reduced with more coordinated care and increased family involvement, according to a RAND Corporation study issued today.

“Our primary objective is to stay focused on treating the whole family, not just the individual,” said Estelle Richman, secretary of the Pennsylvania Department of Public Welfare, who spoke at the news conference in Pittsburgh announcing the study. “The sooner we learn this lesson, the less the need will be for treatment and intervention down the road, and the better will be the lives of our young children and parents. Coordinating our efforts to ensure we maximize our impact is always a complex proposition; but, if we do not, mothers and children are the ones who will continuously suffer.”

The study titled “Improving Maternal and Child Health Care: A Blueprint for Community Action in the Pittsburgh Region” calls for an action plan to help mothers and their children age 5 and younger by:

• Promoting healthy lifestyles and positive health outcomes.
• Reducing preventable disease and environmental health risks.
• Ensuring access to quality health care and social services for all groups.

“Unfortunately, of the more than 14,000 infants born in Allegheny County each year, about 1,200 are born at low birth weight and about 250 are born at very low birth weight,” said Dr. Harold Alan Pincus, director of the RAND-University of Pittsburgh Health Institute and the lead author of the RAND Health report. “Tragically, an average of 100 babies die each year in Allegheny County before their first birthday. African American families in particular are suffering from a disproportionate burden of infant death and poor birth outcomes.”

In the study, families surveyed reported that several barriers hampered their ability to receive needed health care, including: poverty, difficulty accessing services, racial discrimination, balancing health care problems with other basic needs such as housing or food, and competition among agencies to provide child services. Families recommended several key areas in need of development, including a family-focused approach, better access to services, and coordination of services.

Providers of health care services and programs identified several areas for improvement, including: inadequate skills of health care providers, staff shortages, funding and licensing limitations, and insufficient patient transportation services. Patients and providers said there is poor communication among programs and providers, and inadequate integration of services.

Providers also recommended several ways to lower barriers to care, including: strengthening provider and staff skills, enhancing linkages and support relationships among agencies and providers, improving access to information, and developing new types of reimbursement strategies.

The action plan is currently focusing on improving health outcomes for mothers and young children in the East Liberty, Sto-Rox and Braddock communities. Researchers intend to expand the current pilot demonstrations to other at-risk communities.

The report also says policymakers can work to overcome obstacles that prevent families from receiving care and that prevent providers from coordinating care. For example, revising privacy regulations, state laws and Medicaid contracts would enable medical and social service professionals to share information that would help them provide more help to mothers and children.

On a more basic level, policymakers can help families get to appointments by setting Medical Assistance Transportation Program (MATP) standards that allow mothers to bring their dependent children on public transportation, provide a clear mandate regarding transportation across county lines, and establish more specific and uniform guidelines regarding the determination of need for MATP services.

In addition, the study says that policymakers can make it easier for families to receive benefits by working with state and local health care agencies to simplify procedures, and reducing legal and administrative requirements and regulations affecting health care providers.

As an initial step for this multi-phased project, the report mapped out ways for community stakeholders—from the state policy level to the provider level—to implement the action plan throughout 2005, led by the stakeholder group.

State and local policymakers will work to expand the commitment of community stakeholders to improve the health care system from every angle by:

• Increasing public awareness of programs, services, and resources available.
• Better monitoring treatment outcomes.
• Targeting areas for regulatory, licensing, and other policy reforms.
• Boosting advocacy for improving maternal and child health care.
• Promoting the design of financial and other incentives to ensure access to needed services and improved health care quality.
• Establishing new types of provider training, strategies, and practices that will increase family engagement and coordination of care.

RAND worked on the study with the University of Pittsburgh, Allegheny County Department of Health, Allegheny County Department of Human Services, local managed-care organizations, health care provider groups, faith-based organizations, community centers, and families consuming health care and social services.

Other authors of the report, which was commissioned by the Heinz Endowments, are: Donna J. Keyser, Nicholas Castle, Jacob W. Dembosky, Michael D. Greenberg and Nancy Pollock of RAND; Stephen B. Thomas, Ray Firth, Veronica Sansing and Sarah Scholle of the University of Pittsburgh; and Evelyn Reis of Children's Hospital.

An electronic copy of “Improving Maternal and Child Health Care: A Blueprint for Community Action in the Pittsburgh Region” is available at http://www.rand.org/pubs/monographs/MG225/. Printed copies (ISBN: 0-8330-3717-X - paperback) can be ordered from RAND's Distribution Services (order@rand.org or call toll-free in the United States 1-877-584-8642).