*Names in bold indicate Presenter
We use a pre-post design with contemporaneous controls (“differences-in-differences”) within an intent-to-treat framework. The treatment group is comprised of women receiving care at one of 10 intervention clinics and the comparison group is comprised of women receiving care at one of 20 propensity-score matched comparison clinics. Estimates are generated using standard multivariate regression techniques and are clustered at the clinic level. The pre-period spans 2009-2010 and the post-period spans 2011-2013. The analytic sample is constructed from two administrative data sources: medical records (i.e. encounter) data, and Medicaid application/enrollment data; the final analytic sample includes approximately 13,500 women. Outcomes are appropriate prenatal and postpartum health care utilization measures, including dental care receipt, ambulatory care sensitive emergency room visits, and timely post-partum care receipt.
Preliminary results suggest that the intervention was effective in promoting appropriate prenatal and postpartum care utilization, with the largest impact seen for the probability of having a dental visit (magnitude of the impact reflects an approximate doubling of the baseline proportion of 0.19). Importantly, these estimates align with the results from a complementary qualitative implementation study, during which providers discussed extensive efforts to connect patients to dental care. Results are robust to a variety of specification checks, including choice of comparison clinics. Future analysis will incorporate outcome measures drawn from vital statistics data, with a specific focus on gestational age and birth weight.
In conclusion, we find that a PCMH model grounded in the provision of social support services improved appropriate health care utilization among high-risk pregnant Medicaid members.