Kotelchuck Index - The Kotelchuck Index, also called
the Adequacy of Prenatal Care Utilization (APNCU) Index, uses two crucial elements
obtained from birth certificate data-when prenatal care began (initiation) and the
number of prenatal visits from when prenatal care began until delivery (received
services). The Kotelchuck index classifies the adequacy of initiation as follows:
pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9, with
the underlying assumption that the earlier prenatal care begins the better. To classify
the adequacy of received services, the number of prenatal visits is compared to
the expected number of visits for the period between when care began and the delivery
date. The expected number of visits is based on the American College of Obstetricians
and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted
for the gestational age when care began and for the gestational age at delivery.
A ratio of observed to expected visits is calculated and grouped into four categories-Inadequate
(received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%),
and Adequate Plus (110% or more). The final Kotelchuck index measure combines these
two dimensions into a single summary score. The profiles define adequate prenatal
care as a score of 80% or greater on the Kotelchuck Index, or the sum of the Adequate
and Adequate Plus categories.
The Kotelchuck Index does not measure the quality of prenatal care. It also depends
on the accuracy of the patient or health care provider's recall of the timing of
the first visit and the number of subsequent visits. The Kotelchuck Index uses recommendations
for low-risk pregnancies, and may not measure the adequacy of care for high-risk
women. The Kotelchuck Index is preferable to other indices because it includes a
category for women who receive more than the recommended amount of care (adequate
plus, or intensive utilization).
Live Birth -
The complete expulsion or extraction from its mother of a product of human conception,
irrespective of the duration of pregnancy, which, after such expulsion or extraction,
breathes or shows any other evidence of life, such as beating of the heart, pulsation
of the umbilical cord, or definite movement of voluntary muscles, whether or not
the umbilical cord has been cut or the placenta is attached (definition recommended
by the World Health Organization in 1950). Heartbeats are to be distinguished from
transient cardiac contractions; respirations are to be distinguished from fleeting
respiratory efforts or gasps.
- Marital Status on Birth Certificate
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Married- A birth which occurs to a woman who has been married or was married
within 280 days from conception.
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Paternity Acknowledgement - This gives authorization to list the name of
the father on the birth certificate of a child born to an unmarried mother with
written consent of the father and mother by means of an affidavit as required by
South Carolina Law, Section 44-63-165. For statistical purposes, paternity acknowledgements
are included in the married category.
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Unmarried - A birth which occurs to a woman who has never been married or
who has been widowed or legally divorced from her husband in excess of 280 days.
Occurrence Data - Data allocated to the place in
South Carolina where the event occurred, regardless of the usual residence of the
person involved.
Prenatal Care - If a patient went to a Primary Care
physician for a pregnancy test and that is all she received, then this would not
count as a prenatal care visit. However, if the patient, in addition to the pregnancy
test, also received some "risk counseling" (counseling concerning nutrition, e.g.)
then this would count as a prenatal care visit. Only the first day of hospitalization
is counted as a prenatal care visit.
Race - As of 1990, Live Births are reported by race of
mother instead of race of child. This change allows South Carolina's birth data
to be consistent with the National Center for Health Statistics and other states
throughout the United States.
Rate Calculations with Small Numbers - There are
variations in all statistics which are the result of chance. This characteristic
is of particular importance in classifications with small numbers of events where
small variations are proportionately large in relation to the base figure. As an
example, small changes in the number of deaths in small population areas or in the
number of deaths from uncommon causes could result in large changes in these crude
rates. For this reason, rates for counties with small populations or other small
bases should be used cautiously. Multiple-year rates can be calculated to ensure
that these rates are less influenced by chance variations, thus making them more
stable and more appropriate for trend comparisons.
Residence Data - Data allocated to the place in South
Carolina where the person normally resided, regardless of where the event occurred.
Changes in the 2004 birth certificates
In 2004, a revised certificate of live birth was implemented.
This may affect comparisons of variables to previous years. Some of the questions
were removed from the birth certificates while some new ones were added. With some
questions, the way of describing the question or the layout of the questionnaire
were different, thus it is possible that the same variable in the new birth record
has a subtle difference from the old one. If user obtains statistics of both year
2004 and previous years, they should be cautious in interpreting the trend since
it may not be a real trend but due to a different definition or data quality of
the same variable.
To reflect the changes in the new 2004 birth certificate
and avoid the possible confusion to the users, we implemented a dynamic birth characteristics
selection window, in which only appropriate birth characteristics are shown and
selectable depending on the selections of years in step three. Currently there are
three scenarios as listed below,
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Year selection
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Selectable birth characteristics (BC)
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2003 or before
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BC from the original SCAN birth module
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2004 or after
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BC selected from the new 2004 birth certificates
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Both "2003 or before" and "2004 or after"
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BC that are common to both the new and old birth certificates or can be bridged
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