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LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.

Objective. To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice. Data Sources. A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county-level demographic and medical resource characteristics. Deliveries occurring before 35 weeks gestation (n 5 5,150) were used for analysis. Study Design. Logistic regression analysis was used to examine time trends and individual, county, and intervention characteristics associated with delivery at hospitals with NICU, and delivery at the academic medical center. Principal Findings. Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting. Conclusion. Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

The results provide evidence, as other studies have demonstrated, that matching Medicaid claims and vital records data is feasible. However, the matched analytic data set does tend to under-represent the outcomes of high-risk pregnancies. An additional source of selection bias can be avoided by using evidence of pregnancy as the Medicaid index for matching against vital records, rather than using only index cases with evidence of delivery.

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