Developing a measure of prenatal case management dosage.

Area of Science:

• Public Health
• Maternal and Child Health
• Health Services Research

Background:

• Federal funding expanded prenatal case management (PCM) programs via home visitation under the Affordable Care Act.
• Previous studies show limited positive effects of PCM on birth outcomes, potentially due to unassessed dosage.
• Accurate measurement of PCM dosage is essential for evaluating program effectiveness.

Purpose of the Study:

• To demonstrate the utility of measuring PCM dosage in assessing pregnancy outcomes.
• To analyze the relationship between PCM dosage and adverse birth outcomes.

Main Methods:

• A cohort of 4,582 Medicaid-insured Iowa residents with singleton births was analyzed.
• Data from birth, Medicaid claims, and Women's Health Information Systems were linked.
• A dosage measure was created, incorporating enrollment duration, case manager contact time, and intervention breadth.

Main Results:

• PCM dosage showed a significant association with reduced odds of low birth weight (LBW) and preterm birth (PTB).
• Medium and high PCM dosage were significantly associated with lower likelihoods of LBW and PTB compared to low dosage.
• Adjusted odds ratios indicated protective effects for higher PCM dosage levels.

Conclusions:

• PCM dosage is a significant predictor of adverse pregnancy outcomes.
• The findings underscore the importance of quantifying PCM dosage for program evaluation and improvement.
• Optimizing PCM dosage may enhance maternal and child health outcomes.