Issues inherent in measuring the impact of care coordination on pregnancy outcomes

Care coordination is a Medicaid benefit designed to help low-income women gain access to pregnancy-related services. Measuring the outcomes of care coordination is hampered because experimental designs are difficult to carry out on entitlement programs. The purpose of this study was to examine whether a care coordination-adequacy index, based on number of home visits, onset of home visits, and weeks' gestation at delivery, would outperform a simple count of the number of home visits in predicting birthweight. Data from a pilot project in Indianapolis were used. The adequacy index outperformed "number of home visits" in the prediction of birthweight with this sample. Those who received intermediate level of care coordination delivered infants weighing 162 g more than those who received inadequate care coordination. The adequate level of care coordination did not predict birthweight, which may have resulted from an insufficient number of participants in this category (n = 20). An inherent selection bias based on the length of gestation when admitted to the program is also discussed. Research on care coordination with clear delineation of the measurement issues involved must continue to ensure effective program design and continued funding.