Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixedeffects analysis.

Abstract

To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid-covered deliveries. A longitudinal cohort of linked Wisconsin birth records (2008-2012), Medicaid claims, and state-administered social services. We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500g), gestational age (completed weeks), and preterm birth (<37weeks). We estimated PNCC's effect on birth outcomes, adjusting for maternal characteristics, using inverse-probability of treatment weighted and sibling fixedeffects regressions. We identified 136224 Medicaid-paid deliveries, of which 33073 (24.3 percent) linked to any PNCC claim and 22563 (16.6 percent) linked to claims for PNCC service uptake. Sibling fixedeffects models-which best adjust for unobserved confounding and treatment selection-produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P<.05). PNCC's modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.