Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixed effects analysis. (7th November 2019)

• Record Type: Journal Article
• Authors: Mallinson, David C.; Larson, Andrea; Berger, Lawrence M.; Grodsky, Eric; Ehrenthal, Deborah B.
• Is Part Of: Health services research. Volume 55:Number 1(2020)
• Page Start: 82
• Page End: 93
• Publication Date: 2019-11-07
• Subjects: care coordination -- Medicaid -- prenatal; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13239
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract: Objective: To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid‐covered deliveries. Data Source: A longitudinal cohort of linked Wisconsin birth records (2008‐2012), Medicaid claims, and state‐administered social services. Study Design: We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500 g), gestational age (completed weeks), and preterm birth (<37 weeks). We estimated PNCC′s effect on birth outcomes, adjusting for maternal characteristics, using inverse‐probability of treatment weighted and sibling fixed effects regressions. Data Collection/Extraction Methods: We identified 136 224 Medicaid‐paid deliveries, of which 33 073 (24.3 percent) linked to any PNCC claim and 22 563 (16.6 percent) linked to claims for PNCC service uptake. Principal Findings: Sibling fixed effects models—which best adjust for unobserved confounding and treatment selection—produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P < .05). Conclusions: PNCC′s modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.