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A Performance Indicator of Psychosocial Services in Enhanced Prenatal Care of Medicaid-Eligible Women

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Abstract

Objective: Psychosocial services for low-income pregnant women vary widely in practice, and validated indicators of effective performance are lacking. The study presented here aims to determine whether a measure of provider compliance with a psychosocial service delivery guideline is associated with improved birth outcomes and therefore meets an important validity criterion of a performance indicator. Methods: Data on psychosocial services delivered to 3467 pregnant women came from 27 sites certified by the California Department of Health Services to provide enhanced perinatal services to Medicaid-eligible women. Multivariate regression analyses were used to test the association of adequate service delivery according to a performance guideline with birth outcomes and the dependence of the association on the credentials of the provider and the type of practice setting. Results: Women who received at least one psychosocial assessment each trimester of care according to the guideline were half as likely as women with inadequate services to have a low birthweight (OR = 0.49; CI 0.34, 0.71) or preterm birth (OR = 0.53; CI 0.40, 0.72) outcome. The effect did not depend on the credentials of the provider or the practice setting type. Conclusions: The indicator of the adequacy of psychosocial services according to a performance guideline appears to meet a fundamental criterion for a performance indicator, an association with improved outcomes. This indicator may be useful in monitoring performance of enhanced perinatal services for continuous quality improvement of services to low-income pregnant women.

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REFERENCES

  1. Public Health Service. Caring for Our Future: The Content of Prenatal Care. Washington, DC: Public Health Service, 1989.

    Google Scholar 

  2. U.S. General Accounting Office. Medicaid Prenatal Care: States Improve Access and Enhance Services, but Face New Challenges. Washington, DC: U.S. Government Printing Office, 1994.

    Google Scholar 

  3. Farrow DC, Baldwin LM, Cawthon ML, Connell FA. The impact of extended maternity services on prenatal care use among Medicaid women. Am J Prev Med 1996;12:103–107.

    Google Scholar 

  4. Reichman NE, Florio MJ. The effects of enriched prenatal care services on Medicaid birth outcomes in New Jersey. J Health Econ 1996;15:455–476.

    Google Scholar 

  5. Alexander GR, Husley TC, Foley K, Keller E, Cairns K. Assessment of the use and impact of ancillary prenatal care services to Medicaid women in managed care. Matern Child Health J 1998;1:139–149.

    Google Scholar 

  6. Baldwin LM, Larson EH, Connell FA, Nordlung D, Cain KC, Cawthon ML, et al. The effect of expanding Medicaid prenatal services on birth outcomes. Am J Pub Health 1998;88:1623–1629.

    Google Scholar 

  7. Joyce T. Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City. J Health Econ 1998;17:980–989.

    Google Scholar 

  8. Newschaffer CJ, Cocroft J, Hauck WM, Fanning T, Turner BJ. Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus. Obstet Gynecol 1998;91:885–891.

    Google Scholar 

  9. Chalmers I, Enkin M, Keirse M. Effective Care in Pregnancy and Childbirth. London: Oxford University Press, 1989.

    Google Scholar 

  10. Institute of Medicine. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: National Academy Press, 1990.

    Google Scholar 

  11. Joint Commission on Accreditation of Healthcare Organizations. Development and Application of Indicators for Continuous Improvement in Perinatal Care. Oakbrook Terrace, IL: JCAHO, 1992.

    Google Scholar 

  12. Kotelchuck M. The adequacy of prenatal care utilization index: Its US distribution and association with low birthweight. Am J Pub Health 1994;84:1486–1489.

    Google Scholar 

  13. Piper JM, Ray WA, Griffin MR. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA 1990;264:2219–2223.

    Google Scholar 

  14. Ray WA, Mitchel EFJ, Piper JM. Effect of Medicaid expansions on preterm birth. Am J Prev Med 1997;13:292–297.

    Google Scholar 

  15. Donabedian A. Explorations in Quality Assessment and Monitoring. Vol II: The Criteria and Standards of Quality. Ann Arbor, MI: Health Administration Press, 1982.

    Google Scholar 

  16. Raskin IE, Maklan CW. Medical treatment effectiveness research: A view from inside the Agency for Health Care Policy and Research. Eval Health Prof 1991;14:161–168.

    Google Scholar 

  17. Taren DL, Graven SN. The association of prenatal nutrition and educational services with low birth weight rates in a Florida program. Public Health Rep 1991;106:426–436.

    Google Scholar 

  18. Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures [see comments]. JAMA 1994;271(17):1340–1345.

    Google Scholar 

  19. Palmer RH, Adams MM. Quality improvement/quality assurance taxonomy: A framework. Summary Report: Putting Research to Work in Quality Improvement and Quality Assurance 1993;AHCPR Pub. No. 93–004:13–37.

  20. Homan R, Korenbrot CC. Explaining variation in birth outcomes of Medicaid-eligible women with variation in the adequacy of prenatal support services, Medical Care 1998;36:190–198.

    Google Scholar 

  21. Korenbrot CC, Gill A, Clayson Z, Patterson E. Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits. Public Health Rep 1995;110:125–133.

    Google Scholar 

  22. Wilkinson DS, Korenbrot CC, Fuentes-Afflick E. Nonclient factors in the reporting of prenatal psychosocial risk assessments. Am J Pub Health 1994;84:1511–1514.

    Google Scholar 

  23. Wilkinson DR. Psychosocial Services for Low Income Pregnant Women and Their Low Birthweight Outcomes. Berkeley CA: Graduate Division of the University of California; 1995;1–204. Dissertation.

    Google Scholar 

  24. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: Ultrasonic biometry versus certain menstrual date. Am J Obstet Gynecol 1996;174: 278–281.

    Google Scholar 

  25. Reuss ML, Hatch MC, Susser M. Early ultrasound dating of pregnancy: Selection and measurement biases. J Clin Epidemiol 1995;48:667–674.

    Google Scholar 

  26. Institute of Medicine. Preventing Low Birthweight. Washington, DC: National Academy Press, 1985.

    Google Scholar 

  27. Kramer MS. Brith weight and infant mortality: Perception and pitfalls. Paediatric Perinatal Epidemiol 1990;4:381–389.

    Google Scholar 

  28. Simpson L, Korenbrot CC, Greene JD. Outcomes with enhanced prenatal services in private and public settings for Medicaid-eligible women. Pub Health Rep 1997;112:122–132.

    Google Scholar 

  29. Gordis L, Kleinman JC, Klerman LV, Mullen PD, Paneth N. Criteria for evaluating evidence regarding the effectiveness of prenatal interventions. In: Merkatz IR, Thompson JE, eds. New Perspectives on Prenatal Care. New York: Elsevier, 1990.

    Google Scholar 

  30. Liang KY, Zeger SL. Regression analysis for correlated data. Anl Rev Pub Health 1993;14:43–49.

    Google Scholar 

  31. Kogan MD, Martin JA, Alexander GR, Kotelchuck M, Ventura SJ, Frigoletto FD. The changing pattern of prenatal care utilization in the Unites States, 1981–1995, using different prenatal care indices. JAMA 1998;279:1623–1628.

    Google Scholar 

  32. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Pub Health 1994;84:1414–1428.

    Google Scholar 

  33. Alexander GR, Kotelchuck M. Quantifying the adequacy of prenatal care: A comparison of indices. Pub Health Rep 1996;111:408–418; discussion 419.

    Google Scholar 

  34. Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley, 1989.

    Google Scholar 

  35. Korenbrot CC, Homan RK, Wilkinson DS, Greene J. Indicators of Maternity Care for Medicaid Managed Care, Final Report. Rockville, MD: US DHHS HRSA Maternal and Child Health Bureau, 1998.

    Google Scholar 

  36. Institute of Medicine. Medicare: A Strategy for Quality Assurance, Volume I: Sources. Washington, DC: National Academy Press, 1990.

    Google Scholar 

  37. Bryce RL, Stanley FJ, Garner JB. Randomized controlled trail of antenatal social support to prevent preterm birth. Br J Obstet Gynaecol 1991;98:1001–1008.

    Google Scholar 

  38. Spencer B, Thomas H, Morris J. A randomized controlled trial of the provision of a social support service during pregnancy: The South Manchester Family Worker Project. Br J Obstet Gynaecol 1989;96:281–288.

    Google Scholar 

  39. Heins HCJ, Nance NW, McCarthy BJ, Efird CM. A randomized trial of nurse-midwifery prenatal care to reduce low birth weight. Obstet Gynecol 1990;75: 341–345.

    Google Scholar 

  40. Villar J, Farnot U, Barros F, Victora C, Langer A, Belizan JM. A randomized trial of psychosocial support during high-risk pregnancies. N Engl J Med 1992;327:1266–1271.

    Google Scholar 

  41. McLaughlin FJ, Altemeier WA, Christensen MJ, Sherrod KB, Dietrich MS, Stern DT. Randomized trial of comprehensive prenatal care for low-income women: Effect on infant birth weight. Pediatrics 1992;89:128–132.

    Google Scholar 

  42. Ross MG, Sandhu M, Bemis R, Nessim S, Bragonier JR, Hobel C. The West Los Angeles Preterm Birth Prevention Project: II. Cost-effectiveness analysis of high-risk pregnancy interventions. Obstet Gynecol 1994;83:506–511.

    Google Scholar 

  43. Dunkel-Schetter C. Maternal stress and preterm delivery. Prenatal Neonatal Med 1998;3:39–42.

    Google Scholar 

  44. Buescher PA, Ward NI. A comparison of low birth weight among Medicaid patients of public health departments and other providers of prenatal care in North Carolina and Kentucky. Pub Health Rep 1992;107:54–59.

    Google Scholar 

  45. Handler A, Rosenberg D. Improving pregnancy outcomes: Public versus private care for urban, low-income women. Birth 1992;19:123–130.

    Google Scholar 

  46. Kotelchuck M, Kogan MD, Alexander GR, Jack BW. Influence of site of care on the content of prenatal care for low-income women. Maternal Child Health J 1997;1:25–34.

    Google Scholar 

  47. Jencks SF. Measuring quality of care under Medicare and Medicaid. Health Care Financ Rev 1995;16:39–54.

    Google Scholar 

  48. National Committee for Quality Assurance (NCQA). HEDIS 3.0/1998 Volume 2: Technical Specifications. Washington, DC: National Committee for Quality Assurance, 1997.

    Google Scholar 

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Author notes

  1. Deborah Schild Wilkinson

    Present address: Institute for Health Policy Studies and the Department of Obstetrics, Gynecology & Reproductive Sciences. School of Medicine, University of California, San Francisco

Authors and Affiliations

  1. Institute for Health Policy Studies and the Department of Obstetrics, Gynecology & Reproductive Sciences. School of Medicine, University of California, San Francisco

    Carol C. Korenbrot & John Greene

Authors
  1. Deborah Schild Wilkinson
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  2. Carol C. Korenbrot
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  3. John Greene
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Correspondence to Carol C. Korenbrot.

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Wilkinson, D.S., Korenbrot, C.C. & Greene, J. A Performance Indicator of Psychosocial Services in Enhanced Prenatal Care of Medicaid-Eligible Women. Matern Child Health J 2, 131–143 (1998). https://doi.org/10.1023/A:1021823009297

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