University of Illinois School of Public Health, Chicago, IL 60612, USA.
Matern Child Health J. 2012 Feb;16(2):393-405. doi: 10.1007/s10995-011-0763-3.
The aim of this study is to examine the relationship between prenatal care (PNC) provider site and the extent of documented adherence to recommended PNC content, and the relationship between adherence to recommended PNC content and adverse pregnancy outcomes among women in Illinois' Medical Assistance Program (MA). Utilizing the medical record, MA claims, and birth certificate data of 374 women who gave birth in 2003 and 2004 in four high-risk communities in Chicago, crude and adjusted analyses of the relationship between provider site and the extent of documented adherence to PNC content, and between adherence to PNC content and the incidence of low birthweight (LBW) and preterm birth (PTB) were conducted. The extent of documented adherence to recommended PNC content was measured from medical records as the percentage of 19 components of standard obstetrical practice that were delivered during pregnancy, converted to a three level categorical variable (low 50%, medium 50-79% and high 80% or greater). The majority of women had less than 80% of the recommended PNC content documented in their medical records. Among high-risk women, a greater proportion of women served by hospitals received care in which the extent of documented adherence was high (≥80%) compared to women served by physicians'offices (P < 0.05). Among low-risk women, a greater proportion of women served by FQHCs received care in which the extent of documented adherence was high compared to women served by hospitals (P < 0.10). Lower adherence to PNC content was significantly associated with LBW and PTB among women receiving prenatal care from physicians. Examination of the extent of adherence to recommended PNC content and its relationship to adverse pregnancy outcomes provides valuable data to inform potential interventions. In particular, a relationship between adherence to recommended PNC content and LBW and PTB among women receiving PNC at physicians' offices suggests the importance of increased quality assurance and provider education efforts.
本研究旨在探讨产前保健（PNC）提供者所在地与记录的 PNC 内容遵医程度之间的关系，以及在伊利诺伊州医疗补助计划（MA）中接受 PNC 的妇女中，PNC 内容遵医程度与不良妊娠结局之间的关系。利用记录、MA 索赔和 2003 年和 2004 年在芝加哥四个高危社区分娩的 374 名妇女的出生证明数据，对提供者所在地与记录的 PNC 内容遵医程度之间的关系进行了粗分析和调整分析，以及 PNC 内容遵医程度与低出生体重（LBW）和早产（PTB）发生率之间的关系。从病历中测量记录的 PNC 内容遵医程度，将标准产科实践的 19 个组成部分的百分比转换为三水平分类变量（低 50%、中 50-79%和高 80%或更高）。大多数妇女的病历中记录的 PNC 内容不到 80%。在高危妇女中，在医院接受治疗的妇女中，记录的遵医程度较高（≥80%）的比例高于在医生办公室接受治疗的妇女（P < 0.05）。在低危妇女中，在 FQHC 接受治疗的妇女中，记录的遵医程度较高的比例高于在医院接受治疗的妇女（P < 0.10）。较低的 PNC 内容遵医程度与接受 PNC 的妇女的 LBW 和 PTB 显著相关。检查 PNC 内容遵医程度及其与不良妊娠结局的关系，为潜在干预措施提供了有价值的数据。特别是，在医生办公室接受 PNC 的妇女中，PNC 内容遵医程度与 LBW 和 PTB 之间的关系表明，加强质量保证和提供者教育工作的重要性。
