CASE-MANAGEMENT AND PREVENTIVE SERVICES AMONG INFANTS FROM LOW-INCOMEFAMILIES

To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequival ent control group with covariate measures design was employed in a sam ple of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) p rovided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child h ealth care was characterized by fragmentation of services. Case manage ment was segregated from preventive services, and multiple PHNs delive red care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiven ess (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate im munization was 8% less in continuous care ($359) than in the fragmente d approach ($386), although the difference in rates of adequate immuni zation was nonsignificant (experimental group, 64%; control group, 60% ). These findings suggest that continuous PHN care with integrated cas e management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-manageme nt approach.