Related Experiment Video
Updated: Jan 19, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal Outcome Ascertainment in Mother-Infant Paired Claims
Yehua Wang1, Nicole E Smolinski1, Thuy N Thai2
1Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.
Insights
Delayed infant insurance enrollment within 4 weeks maintains sample size and outcome accuracy for neonatal research. This strategy balances case capture and data precision for claims-based studies.
Area of Science:
- Health Services Research
- Perinatal Epidemiology
- Data Analytics in Healthcare
Background:
- Claims data are crucial for studying neonatal outcomes.
- Delayed infant insurance enrollment can lead to misclassification of neonatal outcomes.
- Maternal claims may inaccurately capture infant health events.
Purpose of the Study:
- To evaluate outcome ascertainment accuracy across different infant insurance enrollment scenarios.
- To assess the impact of delayed infant enrollment on neonatal outcome capture.
- To inform strategies for optimizing claims-based perinatal research.
Main Methods:
- Utilized Merative MarketScan databases (2012-2018) in the United States.
- Constructed a mother-infant linked cohort.
- Assessed outcome ascertainment precision with varying infant enrollment requirements.
Main Results:
- Allowing enrollment within 4 weeks retained sample size and doubled case numbers with similar outcome prevalences.
- Maternal claims minimally aided neonatal outcomes but reduced specificity for general outcomes.
- Longer delays reduced outcome prevalence and increased maternal claim contributions, even for neonatal outcomes.
Conclusions:
- Findings guide outcome ascertainment strategies in claims-based perinatal research.
- Emphasizes the need for outcome-specific case ascertainment to balance sensitivity and specificity.
- Delayed infant enrollment within 4 weeks is a viable strategy for neonatal claims research.
Purpose:
Claims data are a valuable source to study neonatal outcomes across a wide range of clinical questions. Infants' delayed enrollment in infant insurance poses challenges in capture of neonatal outcomes, which may be charged to the maternal health plan, posing misclassification risks. We evaluated outcome ascertainment across three infant enrollment scenarios.
Methods:
We used Merative MarketScan databases (2012-2018) in the United States to construct a mother-infant linked cohort and assess the outcome ascertaiment precision with varying infant enrollment requirement.
Result:
We found that allowing delayed infant enrollment in their own insurance within the first 4 weeks of life retained sample size, nearly doubled case numbers and yielded outcome prevalences similar to those of cohorts with full enrollment since birth. Use of maternal claims in addition to infant claims in this cohort made minor contributions to case capture for neonatal-specific outcomes, while significantly decreasing specificity of more general outcomes. Longer delays in enrollment yielded lower outcome prevalences with higher contributions of maternal claims even for neonatal-specific outcomes. For small for gestational age (SGA), both maternal and infant claims contributed similar proportions of cases.
Conclusion:
These findings inform strategies for outcome ascertainment in claims-based perinatal research and emphasize outcome-specific case ascertainment strategies to balance sensitivity and specificity.
