title: Primary care case management and birth outcomes in the Iowa Medicaid program.
abstract: OBJECTIVE
  This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system.
  
  
  METHODS
  Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties.
  
  
  RESULTS
  From 1989 through 1992, there was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups.
  
  
  CONCLUSIONS
  PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes.
authors.affiliation: University of Kentucky, Lexington 40536-0003, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Schulman
authors.forename: D J
authors.initials: DJ
authors.lastname: Sheriff
authors.forename: E T
authors.initials: ET
authors.lastname: Momany
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D018588:Fee-for-Service Plans / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007484:Iowa; D008137:Longitudinal Studies; D008484:Medicaid; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States