Nurse-Family Partnership Impact Evaluation in South Carolina

Composite of at least one health care encounter or mortality associated with International Classification of Diseases (ICD) codes indicating either major injury, or, concern for abuse or neglect for the participant's index child(ren).

Time frame: within 24 months after index birth; Medicaid claims or hospital discharge data

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Composite of at least one of: small for gestational (SGA), or low birth weight (LBW) less than 2500 grams, preterm birth (PTB) less than 37 weeks' gestation (obstetric estimate), or perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life).

Time frame: 0-7 days after index birth; vital records, mortality records, and fetal death records

Population: Differs from randomized sample as it excludes participants who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Having a subsequent birth within the first 21 months of the index birth

Time frame: within 21 months after index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

A continuous measure of infant birth weight (grams)

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Gestational age at birth in weeks (continuous)

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Continuous measure of inter-birth interval

Time frame: 60 months after index birth; vital records

Total number of child visits to the emergency department (without admission)

Time frame: Within 24 months after index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of emergency department visits during pregnancy.

Time frame: At index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of injuries for child

Time frame: Within 24 months after index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Based on all-listed diagnoses (i.e. primary or secondary) for depression/anxiety/stress reaction

Time frame: During index pregnancy or 12 months postpartum; Hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Total months receiving Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families

Time frame: Within 24 months after index birth; South Carolina Department of Social Services data

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants experiencing a cesarean delivery for their index birth.

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

All-cause child mortality in first 24 months of life

Time frame: Within 24 months after index birth; Mortality records

Population: Differs from randomized sample as it excludes participants who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants experiencing all-cause mortality within one year postpartum.

Time frame: Within one year after index birth; mortality records

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants experiencing neonatal abstinence disorder (NAS) or maternal drug/substance abuse in the first two years postpartum.

Time frame: Within two years after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Assisted ventilation immediately after delivery, assisted ventilation for more than six hours, seizure, receipt of surfactant replacement therapy, and receipt of antibiotics for suspected sepsis.

Time frame: At index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life

Time frame: Within 1 week after index birth; mortality records and fetal death records

Population: Differs from randomized sample as it excludes participants who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Severe acute maternal morbidity as defined by the Centers for Disease Control and Prevention (CDC).

Time frame: At index birth; hospital discharge

Population: The analysis population for this outcome includes participants who matched to an index birth in claims data.

Includes any ICD code for healthcare encounter associated with experiencing violence or mortality associated with homicide based on ICD code

Time frame: Within 2 years after index birth; Medicaid claims, mortality records

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

With adequacy defined using the Adequacy of Prenatal Care Utilization Index (APNCU), where prenatal care began by the 4th month and at least 80% of recommended visits were attended

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Received a glucose screen at 24-28 weeks' gestation. Note: Our original prenatal screening outcome variable included the obstetric panel (D \[Rh\], RBC antibody screen, CBC, urine culture, urinalysis), STI screenings (HIV, syphilis, hepatitis B, chlamydia if \<25, gonorrhea if \<25), Group B strep screening, and glucose screening. However, since most participants had already completed their first prenatal visit prior to enrolling in the trial (when many of these tests are performed), it was not appropriate to include first-visit tests as outcomes. We therefore modified the outcome to instead use three clinically relevant measures that could occur after enrollment: glucose screening, Group B strep screening, and Tdap vaccination. These outcomes are reported as they appear in the published papers.

Time frame: At 24-28 weeks' gestation of index pregnancy; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Received implant, IPP-LARC, LARC, or sterilization and moderately effective contraception to include path, ring, diaphragm, injectables and contraceptive pills

Time frame: Within 12 months after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Received implant, immediate postpartum long-acting reversible contraception (IPP-LARC), long-acting reversible contraception (LARC), or sterilization and moderately effective contraception to include path, ring, diaphragm, injectables and contraceptive pills

Time frame: Within 6 weeks after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants who received a postpartum intrauterine device insertion in first 12 months postpartum.

Time frame: Within 12 months after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants who received immediate postpartum long-acting reversible contraception in first 6 weeks postpartum.

Time frame: Within 6 weeks after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Our original prenatal screening outcome variable included the obstetric panel: Rhesus-D (DRh), red blood cell (RBC) antibody screen, complete blood count (CBC), urine culture, urinalysis; sexually transmitted infection (STI) screenings (HIV, syphilis, hepatitis B, chlamydia if \<25, gonorrhea if \<25); Group B strep screening, and glucose screening. However, since most participants had already completed their first prenatal visit prior to enrolling in the trial (when many of these tests are performed), it was not appropriate to include first-visit tests as outcomes. We therefore modified the outcome to instead use three clinically relevant measures that could occur after enrollment: glucose screening, Group B strep screening, and Tdap vaccination. These outcomes are reported as they appear in the published papers.

Time frame: At index birth; Medicaid claims

Number of participants who received Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy.

Time frame: During index pregnancy, assessed up to 42 weeks; South Carolina Department of Social Services data and birth certificate data respectively

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Health care encounter or mortality associated with ICD codes indicating major injury

Time frame: Within 24 months after index birth; Medicaid claims, hospital discharge, mortality records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Health care encounter or mortality associated with ICD codes indicating concern for abuse or neglect

Time frame: Within 24 months after index birth; Medicaid claims, hospital discharge, mortality records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants whose child had at least one visit to the emergency department.

Time frame: Within 24 months after index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Child receives a dental screen at least once in first 24 months

Time frame: Within 24 months after index birth; Medicaid claims and dental records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with a dental visit during pregnancy (preventive or treatment).

Time frame: At index birth; Medicaid claims and dental records

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with a diagnosis of depression/anxiety/stress reaction.

Time frame: During index pregnancy or 60 days postpartum; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants who received any family planning-related counseling or service in the first year postpartum.

Time frame: Within 12 months after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants who received any family planning-related counseling or service.

Time frame: Within 6 weeks after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Received Group B streptococcus test at 35-37 weeks' gestation. Note: Our original prenatal screening outcome variable included the obstetric panel (D \[Rh\], RBC antibody screen, CBC, urine culture, urinalysis), STI screenings (HIV, syphilis, hepatitis B, chlamydia if \<25, gonorrhea if \<25), Group B strep screening, and glucose screening. However, since most participants had already completed their first prenatal visit prior to enrolling in the trial (when many of these tests are performed), it was not appropriate to include first-visit tests as outcomes. We therefore modified the outcome to instead use three clinically relevant measures that could occur after enrollment: glucose screening, Group B strep screening, and Tdap vaccination. These outcomes are reported as they appear in the published papers.

Time frame: At 35-37 weeks' gestation of index pregnancy; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Diagnosis for depression/anxiety/stress reaction or antidepressant prescription or outpatient mental health visit

Time frame: During index pregnancy or 60 days postpartum; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Based on all-listed diagnoses (i.e. primary or secondary) for depression/anxiety/stress reaction

Time frame: During index pregnancy or 12 months postpartum; Hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Second antidepressant prescription or outpatient mental health visit within 120 days of treatment initiation (acute phase)

Time frame: Within 120 days of treatment initiation; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with an antidepressant prescription.

Time frame: During index pregnancy or 60 days postpartum; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with an infant born before 28 weeks' gestation.

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Infant admitted to the neonatal intensive care unit (NICU) for at least one night

Time frame: At index birth; hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, those who experienced an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Infant birth weight above the 90th percentile for infants of the same gestational age

Time frame: At index birth birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Infant birth weight below the 10th percentile for infants of the same gestational age

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with an infant born with a birth weight of less than 2500 grams.

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with an infant born with a birth weight of less than 1500 grams.

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Having a subsequent birth within the first 15 months of the index birth

Time frame: Within 15 months after index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Having a subsequent birth within the first 24 months of the index birth

Time frame: Within 24 months after index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with at least one outpatient mental health visit.

Time frame: During index pregnancy or 60 days postpartum; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with an ultrasound (anatomy scan) at 18-22 weeks.

Time frame: 18-22 weeks gestation during index pregnancy. Assessed at index birth using Medicaid claims.

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants with a postpartum visit in first 12 weeks after an index birth.

Time frame: Within 12 weeks after index birth; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Infant born before 37 weeks' gestation (obstetric estimate)

Time frame: At index birth; vital records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Received Tdap vaccination at 27-36 weeks' gestation. Our original prenatal screening outcome variable included the obstetric panel (D \[Rh\], RBC antibody screen, CBC, urine culture, urinalysis), STI screenings (HIV, syphilis, hepatitis B, chlamydia if \<25, gonorrhea if \<25), Group B strep screening, and glucose screening. However, since most participants had already completed their first prenatal visit prior to enrolling in the trial (when many of these tests are performed), it was not appropriate to include first-visit tests as outcomes. We therefore modified the outcome to instead use three clinically relevant measures that could occur after enrollment: glucose screening, Group B strep screening, and Tdap vaccination. These outcomes are reported as they appear in the published papers.

Time frame: At 27-36 weeks' gestation of index pregnancy; Medicaid claims

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants whose child received at least one developmental screening.

Time frame: At 12 months after index birth; Medicaid claims

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Share with recommended fluoride treatments received by child

Time frame: Within 24 months after index birth; Medicaid claims and dental records

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants whose child received at least one lead screening.

Time frame: At 15 months after index birth; Medicaid claims

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Number of participants that received the recommended number of well-child visits.

Time frame: At 15 months after index birth; Medicaid claims

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Receiving Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families at any time during a given year and having experienced at least one break in participation of four months or less that started and/or ended during the year

Time frame: Within 24 months after index birth; South Carolina Department of Social Services data

Population: Differs from randomized sample as it excludes participants with an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Months from pregnancy to first take up of family planning counseling or service

Time frame: Within 24 months after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.

Months from discharge to first take up of highly effective contraceptive method (include implant, IPP-LARC, LARC, or sterilization)

Time frame: Within 24 months after index birth; Medicaid claims, hospital discharge

Population: Differs from randomized sample as it excludes participants with missing outcome data, an index fetal death, who withdrew, who experienced a pregnancy loss, and who could not be matched to an index pregnancy.