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Field
Primary Outcomes (End Points)
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Before
We will assess the effect of NFP on a range of short- and long-run maternal and child outcomes using administrative data that will be available for all members of both treatment and control groups. Several of the outcomes we will evaluate are required as part of the Medicaid waiver and pay-for-success financing model, and the state is committed to making these data as well as many additional long-run outcomes available to the research team.
We will begin with three outcomes of particular interest to the stakeholders: pre-term birth, birth spacing, and child injuries. These outcomes will form the basis of the pay-for-success payments. Data for pre-term birth and birth spacing will be obtained from Vital Records, collected and maintained by the South Carolina Department of Health and Environmental Control. Data on child injuries will be obtained from an all-payer encounter database overseen by the South Carolina Data Oversight Council.
Our study also aims to assess outcomes of broader interest to the academic and policy communities beyond those specified in the pay-for-success assessment of NFP. The original, smaller-scale studies of NFP suggested that it improved the mothers’ outcomes as well as the children’s, and might have long-term implications for health and well-being that would be of first-order importance in assessing the benefits of public financing of the program. We will also collect administrative data on additional outcomes including health care utilization, mortality, education, abuse and neglect, employment/earnings, use of government services, credit, and crime. South Carolina has a particularly well-developed administrative data infrastructure, and these outcomes are all measurable in administrative data collected by the state and linkable based on the identifiers that will be collected.
This broader evaluation will provide a more comprehensive assessment of the impact of the NFP program, both over a wider array of impacts and over a longer period of time. This will yield useful evidence for the State of South Carolina and for policy-makers nationally, who are interested in comprehensive analyses of the social and economic impact of visiting programs like NFP and on the health and financial consequences of including such visits as a Medicaid benefit.
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After
PRIMARY OUTCOMES
We will consider three outcomes for the Medicaid waiver and pay-for-success (PFS) financing model:
• Pre-term birth: proportion of infants born at less than 37 weeks (vital records, collected and maintained by the South Carolina Department of Health and Environmental Control)
• Birth spacing: number of months from birth of the first child to the subsequent birth (vital records, collected and maintained by the South Carolina Department of Health and Environmental Control)
• Child injuries: fraction of infants with emergency department visits and hospitalizations within 24 months post-partum (all-payer encounter database overseen by the South Carolina Data Oversight Council)
In addition to the outcomes relevant for the PFS evaluation, we will consider other indicators of the impact of NFP outlined below.
Additional non-health outcomes:
• Confirmed cases of abuse and neglect for child or mothers under the age of 18 (from data provided by the Department of Social Services)
• Maternal educational attainment: completion of high school (from data provided by the South Carolina Department of Education)
• Child school readiness and achievement: participation in a state-run pre-kindergarten program, test scores in third grade (from data provided by the South Carolina Department of Education)
• Criminal justice involvement: maternal arrests, child arrests (from data provided by South Carolina Law Enforcement Division and the Department of Juvenile Justice)
We will provide additional details on non-health outcomes prior to the conclusion of study enrollment.
Additional health-related outcomes: health outcomes from vital records birth certificate data (VR), Medicaid claims (MC) data or hospital discharge data (HD).
• Very preterm birth (proportion of infants born at less than 32 weeks)
• Extremely preterm birth (proportion of infants born at less than 28 weeks)
• Low birth weight (proportion of infants born with a birth weight of less than 2500 grams)
• Very low birth weight (proportion of infants born with a birth weight of less than 1500 grams)
• Neonatal intensive care unit (NICU) admission
• Length of stay in NICU (days)
• Short birth interval (proportion of subsequent infants born within 24 months of the first birth)
• Very short birth interval (proportion of subsequent infants born within 18 months of the first birth)
• Delivery method (vaginal delivery or cesarean section)
• Tobacco use
• Long-acting reversible contraception (LARC) use
• Neonatal mortality (proportion of infants that die under 28 days of age)
• Infant mortality (proportion of infants that die under 1 year of age)
• Child mortality (proportion of infants that die under 5 years of age)
• Exceeding recommended pregnancy weight gain (proportion of mothers that exceed recommended pregnancy weight gain)
• Stillbirth
• Gestational diabetes
• Gestational hypertension
• Preeclampsia
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