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01-10-2013

Measuring Dosage: A Key Factor When Assessing the Relationship Between Prenatal Case Management and Birth Outcomes

Authors: Jaime C. Slaughter, L. Michele Issel, Arden S. Handler, Deborah Rosenberg, Debra J. Kane, Leslie T. Stayner

Published in: Maternal and Child Health Journal | Issue 8/2013

Abstract

To assess whether a measure of prenatal case management (PCM) dosage is more sensitive than a dichotomous PCM exposure measure when evaluating the effect of PCM on low birthweight (LBW) and preterm birth (PTB). We constructed a retrospective cohort study (N = 16,657) of Iowa Medicaid-insured women who had a singleton live birth from October 2005 to December 2006; 28 % of women received PCM. A PCM dosage measure was created to capture duration of enrollment, total time with a case manager, and intervention breadth. Propensity score (PS)-adjusted odds ratios (ORs), and 95 % confidence intervals (95 % CIs) were calculated to assess the risk of each outcome by PCM dosage and the dichotomous PCM exposure measure. PS-adjusted ORs of PTB were 0.88 (95 % CI 0.70–1.11), 0.58 (95 % CI 0.47–0.72), and 1.43 (95 % CI 1.23–1.67) for high, medium, and low PCM dosage, respectively. For LBW, the PS-adjusted ORs were 0.76 (95 % CI 0.57–1.00), 0.64 (95 % CI 0.50–0.82), and 1.36 (95 % CI 1.14–1.63), for high, medium, and low PCM dosage, respectively. The PCM dichotomous participation measure was not significantly associated with LBW (OR = 0.95, 95 % CI 0.82–1.09) or PTB (0.97, 95 % CI 0.87–1.10). The reference group in each analysis is No PCM. PCM was associated with a reduced risk of adverse pregnancy outcomes for Medicaid-insured women in Iowa. PCM dosage appeared to be a more sensitive measure than the dichotomous measure of PCM participation.

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Title: Measuring Dosage: A Key Factor When Assessing the Relationship Between Prenatal Case Management and Birth Outcomes
Authors: Jaime C. Slaughter
L. Michele Issel
Arden S. Handler
Deborah Rosenberg
Debra J. Kane
Leslie T. Stayner
Publication date: 01-10-2013
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 8/2013
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-012-1143-3

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Measuring Dosage: A Key Factor When Assessing the Relationship Between Prenatal Case Management and Birth Outcomes

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