Abstract
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.
Similar content being viewed by others
References
Butler, A. S., & Behrman, R. E. (Eds.), (2007). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.
Mathews, T. J., & MacDorman, M. F. (2013). Infant mortality statistics from the 2010 period linked birth/infant death data set. National Vital Statistics Report, 62(8), 1–26.
Schempf, A. H., Branum, A. M., Lukacs, S. L., & Schoendorf, K. C. (2007). The contribution of preterm birth to the black–white infant mortality gap, 1990 and 2000. American Journal of Public Health, 97(7), 1255–1260.
Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2016). Births in the United States, 2015 (NCHS Data Brief, No 258). Hyattsville: National Center for Health Statistics.
MacDorman, M. F., & Mathews, T. J. (2008). Recent trends in infant mortality in the United States (NCHS Data Brief. No 9). Hyattsville: National Center for Health Statistics.
Riddell, C. A., Harper, S., & Kaufman, J. S. (2017). Trends in differences in US mortality rates between black and white infants. JAMA Pediatr, 171(9), 911–913.
Lu, M. C. (2014). Improving maternal and child health across the life course: Where do we go from here? Maternal and Child Health Journal, 18(2), 339–343.
Gallagher, J., Botsko, C., & Schwalberg, R. (2004). Influencing interventions to promote positive pregnancy outcomes and reduce the incidence of low birth weight and preterm infants. Washington, DC: Health Systems Research Inc.
Hill, I. T. (1990). Improving state Medicaid programs for pregnant women and children. Health Care Financing Review, 1990(Suppl), 75–87.
Van Dijk, J. W., Anderko, L., & Stetzer, F. (2011). The impact of prenatal care coordination on birth outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(1), 98–108.
Kroll-Desrosiers, A. R., Crawford, S. L., Simas, T. A. M., Rosen, A. K., & Mattocks, K. M. (2016). Improving pregnancy outcomes through maternity care coordination: A systematic review. Women’s Health Issues, 26(1), 87–99.
Wisconsin Department of Health Services. (2017). Prenatal care coordination. Retrieved from https://www.dhs.wisconsin.gov/mch/pncc.htm.
Wisconsin Department of Health Services. (2009). Forward health: Prenatal care coordination pregnancy questionnaire. Retrieved from https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=54&s=4&c=13&nt=Prenatal+Care+Coordination+Pregnancy+Questionnaire.
U.S. Department of Health and Human Services. (2017). 2016 national healthcare quality and disparities report. Rockville: Agency for Healthcare Research and Quality.
Middleton, B. H., Middleton, R., & Jakpor, K. M. (1992). Evaluation of the Wisconsin Prenatal Care Coordination projects. Madison: Wisconsin Department of Health & Social Services.
Baldwin, L. M., Larson, E. H., Connell, F. A., Nordlund, D., Cain, K. C., Cawthon, M. L., et al. (1998) The effect of expanding Medicaid prenatal services on birth outcomes. American Journal of Public Health, 88(11), 1623–1629.
Buescher, P. A., Roth, M. S., Williams, D., & Goforth, C. M. (1991). An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. American Journal of Public Health, 81(12), 1625–1629.
Piper, J. M., Mitchel, E. F. Jr, & Ray, W. A. (1996). Evaluation of a program for prenatal care case management. Family Planning Perspectives. https://doi.org/10.2307/2136126.
Reichman, N. E., & Florio, M. J. (1996). The effects of enriched prenatal care services on Medicaid birth outcomes in New Jersey. Journal of Health Economics, 15(4), 455–476.
Slaughter, J. C., Issel, L. M., Handler, A. S., Rosenberg, D., Kane, D. J., & Stayner, L. T. (2013). Measuring dosage: A key factor when assessing the relationship between prenatal case management and birth outcomes. Maternal and Child Health Journal, 17(8), 1414–1423.
Hillemeier, M. M., Domino, M. E., Wells, R., Goyal, R. K., Kum, H.C., Cilenti, D., et al. (2015). Effects of maternity care coordination on pregnancy outcomes: Propensity-weighted analyses. Maternal and Child Health Journal, 19(1), 121–127.
Hillemeier, M. M., Domino, M. E., Wells, R., Goyal, R. K., Kum, H.C., Cilenti, D., et al. (2017). Does maternity care coordination influence perinatal health care utilization? Evidence from North Carolina. Health Services Research. https://doi.org/10.1111/1475-6773.12742.
Meghea, C. I., Raffo, J. E., Zhu, Q., & Roman, L. (2013). Medicaid home visitation and maternal and infant healthcare utilization. American Journal of Preventive Medicine, 45(4), 441–447.
Meghea, C. I., You, Z., & Roman, L. A. (2015). A statewide Medicaid enhanced prenatal and postnatal care program and infant injuries. Maternal and Child Health Journal, 19(10), 2119–2127.
Roman, L., Raffo, J. E., Zhu, Q., & Meghea, C. I. (2014). A statewide Medicaid enhanced prenatal care program: Impact on birth outcomes. JAMA Pediatrics, 168(3), 220–227.
The Dartmouth Institute for Health Policy and Clinical Practice. (2017). Atlases and reports. Retrieved from http://www.dartmouthatlas.org/publications/reports.aspx.
Brown, P. A., Ross, D., Smith, J. A., Thornton, K., & Wimer, L. (2011). Technical report on lessons learned in the development of the Institute for Research on Poverty's Multi-Sample Person File (MSPF) data system. Madison, WI: Instititue for Research on Poverty.
U.S. Department of Health and Human Services. (2017). Data. Retrieved from https://datawarehouse.hrsa.gov/data/data.aspx.
U.S. Census Bureau. (2016). Core-based statistical areas. Retrieved from https://www.census.gov/topics/housing/housing-patterns/about/core-based-statistical-areas.html.
Wisconsin Department of Health Services. (2016). WISH query: fertility module. Retrieved from https://www.dhs.wisconsin.gov/wish/fertility/form.htm.
StataCorp. (2017). Stata statistical software: Release 15. College Station, TX: StataCorp LLC.
March of Dimes, Committee on Perinatal Health. (1976). Toward improving the outcome of pregnancy: Recommendations for the regional development of maternal and perinatal health services. White Plains: March of Dimes National Foundation.
American Academy of Pediatrics Committee on Fetus and Newborn. (2012). Levels of neonatal care. Pediatrics, 130(3), 587–597.
Acknowledgements
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.
Funding
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Larson, A., Berger, L.M., Mallinson, D.C. et al. Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context. J Community Health 44, 32–43 (2019). https://doi.org/10.1007/s10900-018-0550-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-018-0550-9