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Perinatal Care

These HEDIS Measures

Prenatal and Postpartum Care

Assesses important facets of prenatal and postpartum care:

  • Timeliness of Prenatal Care: The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization.
  • Postpartum Care: The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Frequency of Ongoing Prenatal Care

The percentage of  deliveries during the measurement period where there were <21 percent, 21–40 percent, 41–60 percent, 61–80 percent or ≥81 percent of the expected number of prenatal care visits, adjusted for gestational age and month of enrollment.

So What?

Although many woman experience uncomplicated pregnancies, timely and adequate prenatal care can prevent poor birth outcomes.1 The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that a woman with an uncomplicated pregnancy be examined every 4 weeks for the first 28 weeks of pregnancy, every 2 to 3 weeks until 36 weeks of gestation and weekly thereafter.2 They also recommend one post-natal visit.2

Appropriate perinatal services and education are crucial components of a healthy birth. Understanding how to stay healthy is important for preventing complications that can affect the health of both mother and baby before, during and after pregnancy.

 

References

1.      National Institutes of Health (NIH). Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2012. “What is prenatal care & why is it important?” www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

2.      American Academy of Pediatrics. American College of Obstetricians and Gynecologists. 2012. “Guidelines for perinatal care.” 7th ed. Elk Grove Village, Illinois, American Academy of Pediatrics, and Washington, D.C.: American College of Obstetricians and Gynecologists.

tables
Frequency of Prenatal Care Visits: <21% of Expected Visits
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  -- -- 11.4  -- --
2015 12.0
2014 14.2
2013 14.3
2012 12.3
2011 10.0
2010 10.4
2009 10.3
2008 11.9
2007 12.4
2006 13.5
2005 16.7
2004 17.9
2003 21.3
2002 27.6
2001 33.1
Frequency of Prenatal Care Visits: 21%–40% of Expected Visits
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  -- -- 7.1  -- --
2015 7.3
2014 7.6
2013 7.6
2012 5.9
2011 6.5
2010 6.9
2009 6.3
2008 6.9
2007 6.6
2006 6.0
2005 5.9
2004 6.7
2003 7.2
2002 7.9
2001 7.5
Frequency of Prenatal Care Visits: 41%–60% of Expected Visits
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  -- -- 8.5  -- --
2015 8.6
2014 8.4
2013 8.5
2012 7.7
2011 8.2
2010 8.1
2009 8.0
2008 8.6
2007 7.7
2006 7.8
2005 7.8
2004 8.0
2003 8.6
2002 9.4
2001 7.3
Frequency of Prenatal Care Visits: 61%–80% of Expected Visits
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  -- -- 14.9  -- --
2015 15.2
2014 14.5
2013 14.0
2012 13.6
2011 14.4
2010 13.6
2009 13.9
2008 14.0
2007 13.8
2006 14.1
2005 13.7
2004 14.2
2003 14.4
2002 13.8
2001 10.5
Frequency of Prenatal Care Visits: ≥81% of Expected Visits
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  -- -- 57.9 -- --
2015 56.6
2014 55.2
2013 55.6
2012 60.4
2011 60.9
2010 61.1
2009 61.6
2008 58.7
2007 59.6
2006 58.6
2005 55.8
2004 51.5
2003 48.2
2002 41.0
2001 39.2
Timeliness of Prenatal Care
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  85.1 76.4 81.7  -- --
2015 83.7 74.9 80.0
2014 87.5 79.6 82.4
2013 90.9 82.2 81.9
2012 89.6 80.9 82.9
2011 91.0 81.9 82.7
2010 91.0 75.7 83.7
2009 93.1 61.9 83.4
2008 92.4 55.5 81.9
2007 91.9 46.0 81.5
2006 90.6 61.9 81.2
2005 91.8 74.6 79.6
2004 90.8 78.2
2003 89.4 76.5
2002 86.7 70.4
2001 85.1 72.9
Postpartum Visit Between 21 and 56 Days After Delivery
  Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016  74.1 65.9 63.7 -- --
2015 73.2 63.1 60.9
2014 76.9 68.4 61.8
2013 80.7 70.9 61.3
2012 80.1 70.0 63.0
2011 80.6 71.3 64.1
2010 80.7 65.9 64.4
2009 83.6 54.1 64.1
2008 82.8 45.8 62.6
2007 82.0 41.6 58.6
2006 79.9 46.3 59.1
2005 81.5 62.8 57.2
2004 80.6 56.5
2003 80.3 55.3
2002 77.0 52.1
2001 77.0 53.0