{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:52:56Z","timestamp":1792075976910,"version":"4.4.0"},"reference-count":17,"publisher":"American Public Health Association","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[1994,9]]},"abstract":"<jats:p>OBJECTIVES. The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner\/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. METHODS. Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. RESULTS. The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. CONCLUSIONS. The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.<\/jats:p>","DOI":"10.2105\/ajph.84.9.1414","type":"journal-article","created":{"date-parts":[[2008,11,29]],"date-time":"2008-11-29T08:18:52Z","timestamp":1227946732000},"page":"1414-1420","source":"Crossref","is-referenced-by-count":914,"title":["An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index."],"prefix":"10.2105","volume":"84","author":[{"given":"M","family":"Kotelchuck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"p_1","unstructured":"Kessner DM, Singer J, Kalk CE, Schlesinger ER. Infant Death: An Analysis by Matemal Risk and Health Care. Washington, DC: Institute of Medicine and National Academy of Sciences; 1973:chap 2."},{"key":"p_2","first-page":"235","volume":"22","author":"Forrest JD","year":"1987","journal-title":"Health Serv Res."},{"key":"p_3","doi-asserted-by":"crossref","unstructured":"Liberatos P, Kiely JL. Selected issues in the evaluation of prenatal care. In: Kiely M, ed. Reproductive and Perinatal Epidemiology. Boca Raton, Fla: CRC Press; 1991: 79-98.","DOI":"10.1201\/9780429278341-7"},{"key":"p_4","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.69.7.653"},{"key":"p_5","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.71.4.381"},{"key":"p_6","doi-asserted-by":"crossref","unstructured":"Showstack JA, Budetti PP, Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation.Am JPublic Health. 1984;74:1003-1008.","DOI":"10.2105\/AJPH.74.9.1003"},{"key":"p_7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198811243192105"},{"key":"p_8","first-page":"111","volume":"99","author":"Placek PJ","year":"1984","journal-title":"Public Health Rep."},{"key":"p_9","unstructured":"Keppel KG, Heuser RL, Placek PJ. Methods and response characteristics, 1980 National Natality and Fetal Mortality Surveys. Vital Health Stat [2]. 1986; no. 100. DHHS publication PHS 86-1374."},{"key":"p_10","unstructured":"Manual of Standards in Obstetric-Gynecologic Practice. 2nd ed. Chicago, Ill: American College of Obstetricians and Gynecologists; 1965."},{"key":"p_11","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.81.8.1013"},{"key":"p_12","unstructured":"Standards for Obstetric-Gynecologic Services. 6th ed. Washington, DC: American College of Obstetricians and Gynecologists; 1985."},{"key":"p_13","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.84.9.1486"},{"key":"p_14","unstructured":"Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept of Health and Human Services; 1991. DHHS publication PHS 91-50212."},{"key":"p_15","first-page":"126","volume":"102","author":"Hogue CJ","year":"1987","journal-title":"Public Health Rep."},{"key":"p_16","unstructured":"Kotelchuck M, Costello CA, Wise PH. Race differences in utilization of prenatal care services in the U.S. Presented at the 115th Annual Meeting of the American Public Health Association; October 18-21, 1987; New Orleans, La."},{"key":"p_17","unstructured":"Kogan MD, Kotelchuck M, Johnson S. Racial differences in late prenatal care visits. JPerinatol. 1993;13:14-21."}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.84.9.1414","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T14:50:27Z","timestamp":1652107827000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.84.9.1414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,9]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[1994,9]]}},"alternative-id":["10.2105\/AJPH.84.9.1414"],"URL":"https:\/\/doi.org\/10.2105\/ajph.84.9.1414","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,9]]}}}