Abstract
This paper considers policy and programmatic consequences of shifting measurement of prenatal care utilization from the Kessner Index (KI) to the Adequacy of Prenatal Care Utilization Index (APNCUI). In gauging the adequacy of prenatal care utilization, the KI considers the timing of prenatal care initiation and the number of prenatal visits. The APNCUI also considers both timing of initiation and number of visits, but the approach taken to conceptualizing and measuring these two aspects of prenatal care utilization is more refined. We used birth certificates to calculate the KI and the APNGUI for 217,183 New York City (NYC) births in 1991-1992. We used cross-tabulations and bivariate odds ratios to compare the classifications resulting from the respective indexes. The APNCUI detected some important dimensions of the problem of inadequate prenatal care use that are not evident when using the KI. The proportion of births with inadequate use increases from 18% with the KI to 35% with the APNGUI. Groups of women at elevated risk for inadequate use are the same, but the KI understates significantly the risk for Hispanic women, teens, women who are less well educated, and those on WIC and Medicaid. The APNGUI yields a fuller picture of the degree to which some urban women are at risk for inadequate prenatal care use. Use of the APNGUI in quality assurance, monitoring, and research is recommended.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Alexander G. R., Korenbrot C. C. The role of prenatal care in preventing low birth weight. Future Child. 1995 Spring;5(1):103–120. [PubMed] [Google Scholar]
- Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994 Sep;84(9):1414–1420. doi: 10.2105/ajph.84.9.1414. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDuffie R. S., Jr, Beck A., Bischoff K., Cross J., Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA. 1996 Mar 20;275(11):847–851. [PubMed] [Google Scholar]
- Sikorski J., Wilson J., Clement S., Das S., Smeeton N. A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project. BMJ. 1996 Mar 2;312(7030):546–553. doi: 10.1136/bmj.312.7030.546. [DOI] [PMC free article] [PubMed] [Google Scholar]