The need for more rigor when measuring and reporting results - studies of prenatal care's effectiveness - Editorial

Are prenatal care programs effective at holding down costs and improving birth outcomes? B&H readers resoundingly say yes. But a recent report challenged that thinking.

Our readers rated prenatal care programs the No. 1 most effective wellness strategy. Among 13 such programs, prenatal care was rated "very effective" in achieving wellness goals by 51% of 595 employers that responded to our annual Executive Opinion Poll.

Yet, as we were publishing the results of our survey ("Workers Shoulder More Health Care Costs," November), the New England Journal of Medicine (Nov. 10) challenged the conventional wisdom regarding prenatal care. Researchers at the Group Health Cooperative and the University of Washington, both in Seattle, pointed out myriad flaws in methodology used nationwide to measure and report prenatal care results. They found for example, that purported savings from prenatal programs sometimes were calculated based on hypothetical results. In these cases, results were measured against what might have been spent had the prenatal care program not been in place. The researchers also found program participants sometimes were self-selected. Since many prenatal programs are voluntary, they often attract healthy women. Pregnant women who are poor or who abuse alcohol or drugs are less likely to participate, the researchers said.

Such flaws in reporting methodology are widespread among employers and health plans that have produced otherwise significant results over the years. B&H also has used less than scientific methodology in reporting on the efforts of employers and health plans to improve outcomes and lower costs.

But there's another side to this story. Just last month, Stewart Beltz, director of employee health management for the CIGNA Insurance Co., in Philadelphia, told us his company saved more than $2 million from its Healthy Babies program. Beltz admits the program's 225 participants were self-selected. Nonetheless, the cost per delivery for participants was $5,141, and the cost for non-participants was $14,116. Participants had fewer complicated pregnancies and 95% had full-term births. Only 83% of the 2,100 non-participants had full-term births. CIGNA's results show that even flawed methodology cannot mask some noteworthy results of employer and health plan prenatal programs that B&H has reported on since 1983.

So, the answer to the question concerning the effectiveness of prenatal care programs is this: Such programs like CIGNA's work and they work well. But those who manage these programs have not used rigorous scientific methods to measure and record results. The time has come for all of us to incorporate higher standards when reporting outcomes.

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