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Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses

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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.

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Authors and Affiliations

  1. Department of Health Policy and Administration, The Pennsylvania State University, 504S Ford Building, University Park, PA, 16802, USA

    Marianne M. Hillemeier

  2. Department of Health Policy and Management, University of North Carolina, Chapel Hill, 1104G McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA

    Marisa E. Domino

  3. Department of Health Policy and Management, Texas A & M University, 1266 TAMU, College Station, TX, 77843, USA

    Rebecca Wells & Hye-Chung Kum

  4. RTI Health Solutions, Chapel Hill, NC, 27599, USA

    Ravi K. Goyal

  5. Department of Maternal and Child Health, University of North Carolina, Chapel Hill, Box 8165, Chapel Hill, NC, 27599, USA

    Dorothy Cilenti

  6. North Carolina State Center for Health Statistics, Raleigh, NC, 27699, USA

    J. Timothy Whitmire

  7. Department of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA

    Anirban Basu

Authors
  1. Marianne M. Hillemeier
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  2. Marisa E. Domino
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  3. Rebecca Wells
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  4. Ravi K. Goyal
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  5. Hye-Chung Kum
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  6. Dorothy Cilenti
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  7. J. Timothy Whitmire
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  8. Anirban Basu
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Correspondence to Marianne M. Hillemeier.

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Hillemeier, M.M., Domino, M.E., Wells, R. et al. Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses. Matern Child Health J 19, 121–127 (2015). https://doi.org/10.1007/s10995-014-1502-3

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  • DOI: https://doi.org/10.1007/s10995-014-1502-3

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