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Preliminary Data

AABC Strong Start is pleased thave its first opportunity to share some of the exciting results of the first three years of the program from a national perspective. The report recently published by the national Strong Start evaluation team has a large enough sample and data about psychosocial risk factors compared between the three models being studied that we can now begin to draw some conclusions. The report compares the participants of AABC Strong Start through Q1 2016—7,570 women—to those enrolled in the other two models of enhanced prenatal care during the same period.


It is important to remember that Strong Start outcomes should not be expected to replicate the outcomes of AABC’s National Birth Center Study II (NBCSII) because many Strong Start participants present with more physical and psychosocial risk factors, and are more racially and ethnically diverse than the population studied in the NBCSII. However, AABC is excited to see that even among Strong Start’s higher-risk population, who are all Medicaid or CHIP recipients, the birth center model produces the best outcomes in many key areas of study.


A surprising finding of the report is that of all Strong Start participants, nearly 26 percent present to care with depression. Even among AABC birth center participants, who tended to have lower rates of most risk factors, the rate of depression was 23%.  In the high-risk population that Strong Start served, depressive symptoms seemed to result from barriers such as unemployment, food insecurity, and lack of support during their pregnancy. Multivariate analyses were conducted on the Strong Start data in this recent report and suggest that there is a significant association between depression and preterm birth as well as depression and low birthweight infants. These findings reinforce the need for mental health issues to be taken seriously by maternity care providers and payers.


Another finding of social and economic stressors was that overall, 19% of all Strong Start participants were food insecure at the first prenatal visit, and 60% were unemployed. Looking at just the AABC participants, 18% were food insecure and 58% were unemployed. This points to the fact that the Strong Start population in birth centers had more stressors than typical low-risk women.


In spite of such increased risks, the results of this recent report are beginning to show what AABC Strong Start staff hoped the birth center model would achieve. We believe that the focus on relationship-building that happens during the longer prenatal visits at birth centers and the emphasis on client education are key contributors to the outcomes beginning emerge from the data. Given the psychosocial challenges that some of the Strong Start moms present with, the additional time provided through the peer counseling element of AABC’s program has potentially helped to reduce preterm birth, and low birthweight babies.


After controlling for demographic and risk factors, birth center participants were found to be the least likely to have a C-section or an elective induction. Although this was expected, it is important that these results stand up after controlling for risk, as birth centers risk out clients with many risk factors that increase the likelihood of needing intervention. These findings are also particularly exciting considering the potential for cost savings from healthier moms and babies and from avoiding unnecessary interventions. The birth center model also had the highest rate among the 3 Strong Start models of women who had a vaginal birth as a percentage of women who planned to deliver vaginally.


While these results are encouraging, we must wait to draw any final conclusions until the national Strong Start evaluation team compiles and analyzes all of the data collected by AABC and other sites. The evaluation team is also collecting state birth certificate and Medicaid claims data to measure the effects of Strong Start for one year post-delivery. AABC looks forward to a complete report that takes into account all enrolled clients and the analysis and discussion that result.

The project described was supported by Funding Opportunity Number CMS-1D1-12-001 from the Centers for Medicare & Medicaid Services, and Center for Medicare & Medicaid Innovation.  The contents of this website do not necessarily represent the official views of HHS or any of its agencies.  This project does not limit a fee-for-service Medicare, Medicaid, or CHIP patient’s freedom to choose a particular health care provider.
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