EXPLAINING VARIATION IN BIRTH OUTCOMES OF MEDICAID-ELIGIBLE WOMEN WITH VARIATION IN THE ADEQUACY OF PRENATAL SUPPORT SERVICES

OBJECTIVES. This study examines the contribution of the adequacy of nu trition, psychosocial, and health education support service delivery i n explaining variation in birth outcomes among Medicaid-eligible women , their provider sites, and practice settings. METHODS. Logistic regre ssion models for low birthweight and preterm birth outcomes are first fitted with medical record data on maternal risks and use of prenatal visits for more than 3,485 women receiving care at 27 ambulatory sites , correcting for clustering of women within sites. RESULTS. The change in variation explained by these models with the addition of the adequ acy of support services indicates that providing at least one nutritio n, psychosocial, and health education service session each trimester o f care contributes significantly to explaining better birth outcomes w hen compared with providing fewer sessions. When the expected outcome rates calculated with the estimated effects in the models are compared with their observed rates across provider sites and setting types, ho wever, adequacy of service delivery does not help to explain differenc es in outcomes at individual sites or types of settings. CONCLUSIONS. Although repeated support service sessions during prenatal care improv e the chances of avoiding poor birth outcomes in low income women, fur ther adjustments for other differences between women or service delive ry are needed to explain variation in outcomes at different sites and practice settings.