Description:

The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following 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.


Denominator:

Product lines
Commercial, Medicaid (report each product line separately).
Age
None specified.
Continuous enrollment
43 days prior to delivery through 56 days after delivery.
Allowable gap
No allowable gap during the continuous enrollment period.
Anchor date
Date of delivery.
Benefit
Medical.
Event/ diagnosis
Delivered a live birth on or between November 6 of the year prior to the measurement year and November 5 of the measurement year. Include women who delivered in any setting.
Multiple births. Women who had two separate deliveries (different dates of service) between November 6 of the year prior to the measurement year and November 5 of the measurement year count twice. Women who had multiple live births during one pregnancy count once.
Follow the steps below to identify the eligible population, which is the denominator for both rates.

Step 1

Identify deliveries. Identify all women with a delivery (Deliveries Value Set) between November 6 of the year prior to the measurement year and November 5 of the measurement year.

Step 2

Exclude non-live births (Non-live Births Value Set).

Step 3

Identify continuous enrollment. Determine if enrollment was continuous between 43 days prior to delivery and 56 days after delivery, with no gaps.


Numerator:

Timeliness of Prenatal Care

A prenatal visit in the first trimester or within 42 days of enrollment, depending on the date of enrollment in the organization and the gaps in enrollment during the pregnancy.
Include only visits that occur while the member was enrolled.
Follow the steps below to identify the numerator.

Step 1

Determine enrollment status during the first trimester. For all women in the eligible population, identify those who were enrolled on or before 280 days prior to delivery (or estimated date of delivery [EDD]). For these women, proceed to step 2.
For women not enrolled on or before 280 days prior to delivery (or EDD), who were therefore pregnant at the time of enrollment, proceed to step 3.

Step 2

Determine continuous enrollment for the first trimester. Identify women from step 1 who were continuously enrolled during the first trimester (176–280 days prior to delivery [or EDD]), with no gaps in enrollment. For these women, determine numerator compliance using the decision rules for Identifying Prenatal Care For Women Continuously Enrolled During the First Trimester.
For women who were not continuously enrolled during the first trimester (e.g., had a gap between 176 and 280 days before delivery), proceed to step 3.

Step 3

Determine the start date of the last enrollment segment (i.e., the enrollment segment during the pregnancy with the start date that is closest to the delivery date).
For women whose last enrollment started on or between 219 and 279 days before delivery, proceed to step 4.
For women whose last enrollment started less than 219 days before delivery, proceed to step 5.

Step 4

Determine numerator compliance. If the last enrollment segment started on or between 219 and 279 days before delivery, determine numerator compliance using the instructions for Identifying Prenatal Care for Women Not Continuously Enrolled During the First Trimester and find a visit between the last enrollment start date and 176 days before delivery.

Step 5

Determine numerator compliance. If the last enrollment segment started less than 219 days before delivery (i.e., between 219 days before delivery and the day of delivery), determine numerator compliance using the instructions for Identifying Prenatal Care for Women Not Continuously Enrolled During the First Trimester and find a visit within 42 days after enrollment.