A performance indicator of psychosocial services in enhanced prenatal care of Medicaid-eligible women.
OBJECTIVE
Psychosocial services for low-income pregnant women vary widely in practice, and validated indicators of effective performance are lacking. The study presented here aims to determine whether a measure of provider compliance with a psychosocial service delivery guideline is associated with improved birth outcomes and therefore meets an important validity criterion of a performance indicator.


METHODS
Data on psychosocial services delivered to 3467 pregnant women came from 27 sites certified by the California Department of Health Services to provide enhanced perinatal services to Medicaid-eligible women. Multivariate regression analyses were used to test the association of adequate service delivery according to a performance guideline with birth outcomes and the dependence of the association on the credentials of the provider and the type of practice setting.


RESULTS
Women who received at least one psychosocial assessment each trimester of care according to the guideline were half as likely as women with inadequate services to have a low birthweight (OR = 0.49; CI 0.34, 0.71) or preterm birth (OR = 0.53; CI 0.40, 0.72) outcome. The effect did not depend on the credentials of the provider or the practice setting type.


CONCLUSIONS
The indicator of the adequacy of psychosocial services according to a performance guideline appears to meet a fundamental criterion for a performance indicator, an association with improved outcomes. This indicator may be useful in monitoring performance of enhanced perinatal services for continuous quality improvement of services to low-income pregnant women.
Wilkinson
D S
DS
Institute for Health Policy Studies, University of California, San Francisco 94143, USA.
Korenbrot
C C
CC
Greene
J
J
D001724:Birth Weight; D002140:California; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D008484:Medicaid; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011295:Prenatal Care; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012947:Social Work / Q000379:methods*; D014481:United States