摘要：We used administrative and screening data from 2009 to 2010 to determine if Healthy Start (HS), an enhanced prenatal services program, is reaching the most vulnerable African American women in Kent County, Michigan. Women in HS are at higher risk of key predictors of birth outcomes compared with other women. To advance toward evidence-based HS program evaluations in the absence of randomized controlled trials, future studies using comparison groups need to appropriately establish baseline equivalence on a variety of risk factors related to birth outcomes. For more than 20 years, the federal Healthy Start (HS) program has worked to reduce disparities in maternal and infant health using a core set of interventions tailored to high-risk communities. 1–3 Strong Beginnings, the Grand Rapids, Michigan, HS program, uses a community collaborative model that builds on the state Medicaid-sponsored enhanced prenatal services program, the Michigan Maternal and Infant Health Program (MIHP). MIHP services are available to all Medicaid-insured pregnant women and infants and include case management through office or home visits provided by nurses or social workers employed in multiple community agencies. 4 All African American pregnant women in Kent County are eligible for Strong Beginnings HS, and the program relies on outreach, referrals, and other strategies to enroll women at greater risk for adverse birth outcomes. The HS program pairs MIHP professionals with community health workers and mental health coordinators to provide more intensive services. 5 HS evaluations, with 1 exception, received low federal evidence-based ratings because they used quasi-experimental designs that did not establish the study groups equivalence at baseline. 6–9 One randomized trial HS evaluation compared high intensity to typical HS home visits, and therefore, was not considered evidence of effectiveness. 10 Previous HS studies were unable to properly account for potential bias introduced by differences between HS participants, women in other enhanced prenatal programs, and nonparticipants, along with risk factors known to be predictors of adverse birth outcomes. 6–9,11,12 To fill this research gap, we aimed to determine if the Strong Beginnings HS program is reaching African American women who are at greater risk than those in traditional MIHP or those in Medicaid. We presented risk factors previously not included in HS effectiveness studies. This would inform future evidence-based HS evaluations on the extent of the differences and the need to establish comparison group equivalence on specific characteristics.
