{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:44:08Z","timestamp":1791499448642,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T00:00:00Z","timestamp":1452729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000124","name":"Office of Research on Women's Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000124","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR000114"],"award-info":[{"award-number":["UL1TR000114"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>One in nine <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> infants is born before 37 weeks' gestation, incurring medical costs 10 times higher than full\u2010term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (nonmedical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost\u2010effectiveness of Medicaid coverage of doula services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data came from two sources: all Medicaid\u2010funded, singleton births at hospitals in the West North Central and East North Central <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> (<jats:italic>n<\/jats:italic> = 65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid\u2010funded singleton births (<jats:italic>n<\/jats:italic> = 1,935) supported by a community\u2010based doula organization in the Upper Midwest from 2010 to 2014. We analyzed routinely collected, de\u2010identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision\u2010analytic model was used for cost\u2010effectiveness estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7 vs 6.3%, and 20.4 vs 34.2%). After adjustment for covariates, women with doula care had 22 percent lower odds of preterm birth (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content> 0.77 [95% CI 0.61\u20130.96]). Cost\u2010effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986 (ranging from $929 to $1,047 across states).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Based on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost\u2010effective for state Medicaid programs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12218","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T18:34:18Z","timestamp":1452796458000},"page":"20-27","source":"Crossref","is-referenced-by-count":161,"title":["Modeling the Cost\u2010Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery"],"prefix":"10.1111","volume":"43","author":[{"given":"Katy B.","family":"Kozhimannil","sequence":"first","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel R.","family":"Hardeman","sequence":"additional","affiliation":[{"name":"Division of Health Care Policy &amp; Research (HCPR) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Alarid\u2010Escudero","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie A.","family":"Vogelsang","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cori","family":"Blauer\u2010Peterson","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Howell","sequence":"additional","affiliation":[{"name":"Departments of Population Health Science &amp; Policy and Obstetrics Gynecology, and Reproductive Sciences Center for Health Equity and Community Engaged Research Icahn School of Medicine at Mount Sinai New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,14]]},"reference":[{"issue":"2","key":"e_1_2_7_2_1","first-page":"1","article-title":"National vital statistics reports births: Preliminary data for 2013","volume":"63","author":"Hamilton BE","year":"2014","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.026"},{"issue":"4","key":"e_1_2_7_4_1","first-page":"1","article-title":"Deaths: Final data for 2010","volume":"61","author":"Murphy SL","year":"2014","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_5_1","unstructured":"Truven Health Analytics.The Cost of Having a Baby in the United States. 2013. Accessed February 10 2015. Available at:http:\/\/transform.childbirthconnection.org\/reports\/cost\/."},{"key":"e_1_2_7_6_1","volume-title":"Preterm Birth: Causes, Consequences, and Prevention","author":"Behrman R","year":"2006"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2013.06.006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2009.11.012"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301201"},{"key":"e_1_2_7_10_1","unstructured":"Oregon Health Authority Office of Equity and Inclusion.Oregon Legislature House Bill 3311\u2014Doula Report. Accessed February 10 2015. Available at:http:\/\/www.oregon.gov\/oha\/legactivity\/2012\/hb3311report-doulas.pdf."},{"key":"e_1_2_7_11_1","unstructured":"Minnesota State Legislature.2013.Minnesota State Legislature State Senate Bill 699. Minnesota Statutes 2012 Section 256B.0625 Doula Services section 148.995 Subdivision 2. Accessed February 10 2015. 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