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Objectives Because previous analyses of prenatal care (PNC) utilization and risk of low birth weight (LBW) may have been influenced by selection bias, we conducted a study using longitudinal data of women with repeat pregnancies. Methods We analyzed Washington State birth certificates of first and second live births (2003-2012). We estimated relative risk (RR) of LBW at second birth associated with Kotelchuck Index PNC level among women stratified by level of PNC in their first birth (n = 67,571). Results Among women with inadequate PNC prior to their first birth (n = 10,355), women with intermediate or adequate PNC before their second birth (n = 7464) had a reduced risk of LBW (adjusted RR 0.61, 95 % CI: 0.48, 0.78) compared to those whose PNC level remained inadequate. Likewise, among women with intermediate or adequate PNC prior to their first birth (n = 57,216), those with inadequate PNC before the second birth (n = 7095) had higher risk of LBW (adjusted RR 1.59, 95 % CI: 1.36, 1.85) compared to those who remained at intermediate or adequate PNC. Conclusions Our findings support the hypothesis that PNC decreases LBW risk at second birth, independent of factors related to the utilization of PNC at first birth., Author(s): Christine T. Loftus [sup.1] , Orion T. Stewart [sup.1] , Mark D. Hensley [sup.1] , Daniel A. Enquobahrie [sup.1] , Stephen E. Hawes [sup.1] Author Affiliations: (1) Department of [...]

The California Department of Health Care Services (DHCS) administers the nation's largest Medicaid program. In 2012, DHCS developed a Quality Strategy modeled after the National Quality Strategy to guide the Department's activities aimed at advancing the Triple Aim. The Triple Aim seeks to improve the patient experience of care and the health of populations as well as reduce the per capita cost of health care. An academic team was contracted to assist DHCS in developing the strategy, which also was informed by extensive stakeholder input, an advisory committee, and a comprehensive inventory of DHCS quality improvement (QI) activities. From 2012 to 2018, the strategy included 129 unique QI activities. Most activities were intended to deliver more effective, efficient, affordable care or to advance disease prevention. This qualitative assessment of the DHCS Quality Strategy provides insights that may inform other Medicaid programs or large health systems as they develop quality strategies. [ABSTRACT FROM AUTHOR]