Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses
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Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses Marianne M. Hillemeier • Marisa E. Domino • Rebecca Wells Ravi K. Goyal • Hye-Chung Kum • Dorothy Cilenti • J. Timothy Whitmire • Anirban Basu
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Ó Springer Science+Business Media New York 2014
Abstract Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination (MCC) on pregnancy outcomes in North Carolina. Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received MCC services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to
conventional ordinary least squares analyses. The unadjusted preterm birth rate was lower among women who received MCC services (7.0 % compared to 8.3 % among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 % point reduction in preterm birth risk; p \ 0.05). MCC services were also associated with lower pregnancy weight gain (p = 0.10). No effects of MCC were seen for birthweight. These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome.
M. M. Hillemeier (&) Department of Health Policy and Administration, The Pennsylvania State University, 504S Ford Building, University Park, PA 16802, USA e-mail: [email protected]
D. Cilenti Department of Maternal and Child Health, University of North Carolina, Chapel Hill, Box 8165, Chapel Hill, NC 27599, USA e-mail: [email protected]
M. E. Domino Department of Health Policy and Management, University of North Carolina, Chapel Hill, 1104G McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA e-mail: [email protected] R. Wells H.-C. Kum Department of Health Policy and Management, Texas A & M University, 1266 TAMU, College Station, TX 77843, USA e-mail: [email protected]
J. Timothy Whitmire North Carolina State Center for Health Statistics, Raleigh, NC 27699, USA e-mail: [email protected] A. Basu Department of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA e-mail: [email protected]
H.-C. Kum e-mail: [email protected] R. K. Goyal RTI Health Solutions, Chapel Hill, NC 27599, USA e-mail: [email protected]
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Matern Child Health J
Keywords Care coordi
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