An exploration of variations in birth outcomes using PRAMS data guided by the quality health outcomes model

Preterm birth, defined as delivery prior to 37 weeks gestation, is a leading cause of infant mortality and morbidity in the US. Prenatal care is associated with a decrease in preterm births, but high risk women often receive less care. The Quality Health Outcomes Model suggests the interaction between clients and health care systems mediates the effects of interventions on outcomes. Secondary analysis of PRAMS (Pregnancy Risk Assessment Monitoring System) data was used to examine whether women's interactions with the health care system during pregnancy were associated with variations in the outcome of gestational age.; The target sample consisted of 10,783 Michigan women who had a live birth between 1996 and 1999 and were selected for the PRAMS population-based survey. The MI PRAMS survey is mailed to a systematic, stratified sample of 200 postpartum women selected from birth certificate files each month. Of those selected, 67% (n = 7,257) responded to the survey and 66% (n = 4,431) had complete data for this study.; The median age was 26 years, 59% were married, 47% were African American, and 51% were white. The mean gestation was 37.34 weeks, SD = 3.58. History of preterm birth accounted for the most unique variance (8%) in regression analyses. There were no significant differences in gestation between women: with or without insurance prior to pregnancy; who began care when they wanted or did not; and who were satisfied or unsatisfied. Gestation was shorter for women who did not receive information on early labor (t = -9.01, p < .01) and for women who did not receive services for self-identified needs (t = -4.15, p < .01). Over 50% of women who needed services for violence, stress, and smoking did not receive them. Poor women and African American women were more likely to receive messages about negative health behaviors.; These study results partially supported the model and suggested that not receiving information or services had a negative effect on outcomes. Women at greatest risk, based on demographics and reproductive history, received fewer preventive and supportive services. The effect of client and health care system interactions, especially provider behavior, on health outcomes requires further study.