Identifying Pregnant Substance Abusers and Studying Their Treatment Using Birth Certificates, Medicaid Claims, and State Substance Abuse Treatment Data

Article excerpt

A substantial body of recent research has focused on the prevalence of substance abuse among pregnant women, its effects on maternal and infant health, ways to identify and effectively treat pregnant women, and the cost of care for pregnant women and their infants. However, this research has been hampered by a lack of data, particularly of the state and local levels. The potential benefits of such research for improving treatment and other services to this high-risk group make if important to continue to develop accurate and timely data sources. This study builds on previous work that investigated the quality of birth certificate and Medicaid data as well as previous efforts to merge these two data sources by augmenting the merged birth certificates and Medicaid data with data on a group of known substance abusers - those in substance abuse treatment. The purpose of merging these records is to improve the identification of pregnant substance abusers and, more importantly, to provide an enriched data source of variables from all three sources. Using merged data from two example states, we show that linked birth certificates, Medicaid claims, and state substance abuse treatment files provide a useful source of information for studying the birth outcomes and costs for pregnant women in substance abuse treatment. However, certain groups, such as women who do not obtain any health care or substance abuse treatment, will be underrepresented in such a database. Consequently, efforts at more complete surveillance of pregnant substance abusers should be undertaken, perhaps through increased efforts to improve reporting on the birth certificate, which is a universal document.

BACKGROUND AND RESEARCH ISSUES

A substantial body of recent research has focused on the prevalence of substance abuse among pregnant women, its effects on maternal and infant health, and effective ways to identify and treat pregnant women (Howell et al. 1999; Chasnoff 1988; Horgan et al. 1991 ). However, conducting research on this important subject has been hampered by a lack of data, particularly at the state and local levels. There have been some national-level prevalence studies, including the National Maternal and Infant Health Survey (Centers for Disease Control and Prevention 1994) and National Pregnancy and Health Survey (National Institute on Drug Abuse 1996). The state-specific Pregnancy Risk Assessment Monitoring System is used to measure problem drinking during pregnancy in some states (Bruce et al. 1993). However, these sample surveys cannot be used to measure substance abuse among pregnant women at the local level.

Records that are routinely collected for administrative purposes are increasingly used for research on other topics. These databases, once in computer-- accessible form, can provide a low-cost means of avoiding direct primary data collection. If such databases can be linked, they could provide an even more useful data source because of the additional information that can be obtained from multiple sources. The purpose of this paper is to provide an overview of the process of matching and merging administrative records so that researchers appreciate both the difficulties of using such records and the weaknesses and strengths of the merged data.

There are potential problems with using records that are collected for an administrative purpose for research since the data may be incomplete or of otherwise poor quality. Investigating data quality is consequently one of the most important first steps in using such data for research.

In the case of substance abuse research, one of the most important aspects of data quality is the actual reporting of substance use or abuse in administrative records. A concern for maternal confidentiality may lead providers to underreport substance use. This is particularly true in states that have taken punitive action against pregnant/postpartum women who use drugs or alcohol, since reporting women could make them subject to incarceration or losing custody of their newborns. …