Table 1 NFP program objectives and corresponding primary and secondary outcomes
Data source(s) | Time at complete outcome observation (time since all pregnancies completed) | |
|---|---|---|
Objective 1. Improve pregnancy, birth, and maternal health outcomes | ||
Primary outcome | ||
Composite of at least one of: • Small for gestational age, or • Low birth weight (less than 2500 g), or • Preterm birth (less than 37 weeks’ gestation by obstetric estimate), or • Perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life) | Birth certificates, fetal death records, mortality records | 1 months (Feb 2021) |
Secondary outcomes | ||
Infant outcomes observed at birth | ||
Small for gestational age | Birth certificates | 0 months (Jan 2021) |
Large for gestational age | Birth certificates | 0 months (Jan 2021) |
Low birth weight (< 2500 g) | Birth certificates | 0 months (Jan 2021) |
Very low birth weight (< 1500 g) | Birth certificates | 0 months (Jan 2021) |
Birth weight (continuous) | Birth certificates | 0 months (Jan 2021) |
Preterm birth (< 37 weeks’ gestation by obstetric estimate)1 | Birth certificates | 0 months (Jan 2021) |
Extremely preterm (< 28 weeks’ gestation) | Birth certificates | 0 months (Jan 2021) |
Gestational age at birth in weeks (continuous) | Birth certificates | 0 months (Jan 2021) |
Perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life) | Fetal death records, mortality records | 1 months (Feb 2021) |
NICU admission of at least overnight | Hospital discharge | 0 months (Jan 2021) |
Neonatal morbidity2 | Hospital discharge | 0 months (Jan 2021) |
Maternal outcomes | ||
Cesarean delivery | Birth certificates | 0 months (Jan 2021) |
Severe acute maternal morbidity3 | Hospital discharge | 0 months (Jan 2021) |
Maternal mortality (up to 1 year after birth) | Mortality records | 12 months (Jan 2022) |
Neonatal abstinence disorder or maternal drug/substance abuse | Medicaid claims, hospital discharge | 24 months (January 2023) |
Maternal experience of violence or homicide4 | Medicaid claims, mortality records | 24 months (January 2023) |
Postpartum visit within the first 12 weeks postpartum | Medicaid claims | 2 months (March 2021) |
Utilization and quality of prenatal care | ||
Adequate prenatal care (Adequacy of Prenatal Care Utilization (APNCU) Index) | Birth certificates | 0 months (Jan 2021) |
Number of emergency department visits during pregnancy | Hospital discharge | 0 months (Jan 2021) |
Dental visit (preventive or treatment) during pregnancy | Medicaid medical and dental claims | 0 months (Jan 2021) |
Ultrasound at 18–22 weeks (anatomy scan) | Medicaid claims | 0 months (Jan 2021) |
Proportion of recommended prenatal screenings completed5 | Medicaid claims | 0 months (Jan 2021) |
Mental health outcomes | ||
Any outpatient treatment or diagnosis6,7 | Medicaid claims | 2 months (March 2021) |
Diagnosis of depression/anxiety/stress reaction6 | Medicaid claims | 2 months (March 2021) |
Antidepressant prescription6 | Medicaid claims | 2 months (March 2021) |
Outpatient mental health visit6 | Medicaid claims | 2 months (March 2021) |
Treatment follow-up8 | Medicaid claims | 6 months (July 2021) |
Mental health-related emergency/inpatient visit9 | Hospital discharge | 12 months (January 2022) |
Number of mental health-related emergency/impatient visits9 | Hospital discharge | 12 months (January 2022) |
Objective 2. Improve child health and development | ||
Primary outcome | ||
Composite of at least one health care encounter or mortality associated with ICD codes indicating at least one of the following: • Major injury, or • Concern for abuse or neglect | Medicaid claims, hospital discharge, mortality files (defined in Tables 2 and 3) | 24 months (January 2023) |
Secondary outcomes | ||
Accidents, suspected abuse and neglect and emergency care utilization | ||
Health care encounter or mortality associated with ICD codes indicating major injury | Medicaid claims, hospital discharge, mortality files (defined in Table 2) | 24 months (January 2023) |
Health care encounter or mortality associated with ICD codes indicating concern for abuse or neglect | Medicaid claims, hospital discharge, mortality files (defined in Table 3) | 24 months (January 2023) |
Number of injuries10 | Hospital discharge | 24 months (February 2023) |
Any emergency department visit | Hospital discharge | 24 months (January 2023) |
Number of emergency department visits | Hospital discharge | 24 months (January 2023) |
All-cause child mortality in first 24 months of life or fetal death | Fetal death records, mortality records | 24 months (January 2023) |
Outcomes related to preventative care | ||
Proportion of recommended well-child visits | Medicaid claims | 15 months (April 2022) |
At least one lead screening | Medicaid claims | 15 months (April 2022) |
At least one developmental screening11 | Medicaid claims | 12 months (January 2022) |
At least one dental visit12 | Medicaid medical and dental claims | 24 months (January 2023) |
Share of recommended fluoride treatments13 | Medicaid medical and dental claims | 24 months (January 2023) |
Objective 3. Alter maternal life course | ||
Primary outcome | ||
Inter-birth interval of < 21 months | Birth certificates | 21 months (October 2022) |
Secondary outcomes | ||
Birth spacing outcomes | ||
Inter-birth interval of < 24 months14 | Birth certificates | 24 months (January 2023) |
Inter-birth interval of < 15 months | Birth certificates | 15 months (April 2022) |
Inter-birth interval (continuous) | Birth certificates | 60 months (January 2026) |
Postpartum family planning while enrolled in postpartum Medicaid coverage (6 weeks) | ||
Any family planning related counseling or service | Medicaid claims, hospital discharge15 | 6 weeks (March 2021) |
Received a highly or moderately effective method of contraception16 | Medicaid claims, hospital discharge | 6 weeks (March 2021) |
Immediate postpartum long-acting reversible contraception | Medicaid claims, hospital discharge | 6 weeks (March 2021) |
Postpartum family planning within 1 year | ||
Any family planning related counseling or service | Medicaid claims, hospital discharge | 12 months (January 2022) |
Received a highly or moderately effective method of contraception16 | Medicaid claims, hospital discharge | 12 months (January 2022) |
Postpartum intrauterine device insertion | Medicaid claims, hospital discharge | 12 months (January 2022) |
Timing of postpartum family planning take-up | ||
Time to first family planning counseling or service (months from pregnancy) | Medicaid claims, hospital discharge | 24 months (January 2023) |
Time to first utilization of highly effective contraceptive methods (months from discharge) | Medicaid claims, hospital discharge | 24 months (January 2023) |