The long-term goals of this study are to improve health and reduce health care costs for children of low-income families by increasing utilization of Early and Periodic Screening, Diagnosis prevention (HPDP) services for Medicaid-eligible children from birth to age 21. EPSDT, when used, has been shown to improve health and reduce health care costs. However, utilization is extremely low (6-62% of eligibles nationally; 31% in North Carolina [NC]; lowest in rural areas).
Specific aims of the study are to test the effectiveness, cost-effectiveness, and efficacy of public health nursing (PHN) interventions to improve utilization of EPSDT in rural NC. The interventions are carefully designed to address predisposing factors specific to the target population and to represent increasing levels of enabling and reinforcing factors, with concurrent increases in costs. The strategies to be tested include mailed pamphlets designed specially for the target population; structured phone calls by a PHN; and structured home visits by a PHN accompanied by an aide. These methods will be tested against the usual (control) method of informing parents about EPSDT at the Medicaid eligibility interview. Pilot testing (n-100) showed that our research methods are feasible, our instruments are valid and reliable, and that our interventions are likely to improve EPSDT utilization and are worthy of definitive testing with a larger sample. We will conduct such testing in a multigroup randomized experiment in 6 rural NC counties, with a random sample (proportionate by counties, and stratified by presence of phone) of 2548 Medicaid households with >1 eligible child (age 0-20) not using EPSDT in >1 year. Our instruments and NC Medicaid eligibility and claims files provide the study variables, is in terms of EPSDT use <4 months after intervention. Data analysis includes logistic regression, odds ratios with confidence intervals, and z-tests. Results will provide heretofore unavailable information to help nurses allocate scarce resources to actions most likely to increase utilization of a program with well- established health benefits. In so doing, this study addresses one of the thorniest issues facing public health nursing: utilization of existing resources. The research findings will have broad implications for practice and research regarding methods of bringing HPDP information to rural, underserved, low-literate, poor minority populations.
