Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context
Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin’s Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among those assessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCC services. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination’s effects on birth outcomes should account for service context and the treatment level into which participants select.
KeywordsPrenatal care Medicaid Care coordination
Support was provided by the University of Wisconsin-Madison Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS), Grant UL1TR00427, as well as the University of Wisconsin-Madison School of Medicine and Public Health’s Wisconsin Partnership Program (WPP) and the Institute for Research on Poverty. We are grateful for excellent data access and programming assistance provided by Steven T. Cook, Dan Ross, Jane A. Smith, Kristen Voskuil, and Lynn Wimer. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or WPP. The authors would like to thank the Wisconsin Department of Children and Families, Department of Health Services and Department of Workforce Development for the use of data for this analysis, but these agencies do not certify the accuracy of the analyses presented.
Support was provided by the University of Wisconsin-Madison Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS), Grant UL1TR00427, as well as the University of Wisconsin-Madison School Medicine and Public Health’s Wisconsin Partnership Program (WPP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or WPP.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Research Involving Human Participants and/or Animals
The study did not directly involve human participants and/or animals. All study procedures were approved by an institutional review board.
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