Defining, measuring, and evaluating prenatal care in insurance claims data

Area of Science:

• Perinatal Epidemiology
• Health Services Research

Background:

• Insurance claims data are vital for perinatal epidemiology research.
• Prenatal care is a key intervention but lacks a consistent definition in research and clinical settings.
• Accurate identification of prenatal care encounters in claims data is challenging.

Purpose of the Study:

• To discuss the complexities of identifying prenatal care visits in insurance claims databases.
• To review existing methods for identifying prenatal care encounters.
• To explore how study goals should influence the definition of prenatal care used by investigators.

Main Methods:

• Categorized definitions of prenatal care into three groups: all healthcare during pregnancy, pregnancy-specific healthcare, and guideline-concordant healthcare.
• Identified five common methods used in insurance claims data studies to identify prenatal care encounters.
• Utilized example study goals to illustrate considerations for applying different identification methods.

Main Results:

• Prenatal care definitions vary, impacting study outcomes.
• Five distinct methods for identifying prenatal care encounters were identified in claims data research.
• The choice of method for identifying prenatal care visits should align with specific research objectives.

Conclusions:

• Researchers must carefully consider their study goals when selecting a definition and method for identifying prenatal care in insurance claims data.
• Standardizing definitions and methods could improve the reliability of perinatal epidemiology studies.
• This work provides a framework for investigators to make informed decisions regarding prenatal care identification in claims data.