Definitions of health services exposure/outcome variables
| Variable | Time frame | Database | Operation definition/ICD codes |
|---|---|---|---|
| Physician visits | |||
| Ambulatory care visits | 1 year prior to birth of index child | Physician claims | Ambulatory visits are defined as all contacts with physicians (family practitioner and specialists) that do not include hospitalisations. These visits include office visits, walk-in clinics, home visits, personal or home/nursing home visits and outpatient department's visits. They do not include emergency department visits. The type of visit is determined by a tariff code in the physician claims data |
| Hospital visits | |||
| Hospitalisations | 3 years before the birth of the child | Hospital Abstracts | A woman was considered to have a hospitalisation if a billing claim was submitted to the provincial government for services a hospital had provided in order to receive reimbursement for care. These services include physician visits, laboratory/pathology, X-ray/radiology, surgical services, anaesthesia, postoperative care |
| Antenatal hospitalisations | During the pregnancy of the index child | Hospital Abstracts | An antenatal hospitalisation is a hospitalisation in which a woman was pregnant but did not deliver during the hospitalisation of the index child. Reasons include threatened preterm labour, haemorrhage, diabetes, hypertensive disorders, abdominal pain etc. A woman was considered to have an antenatal hospitalisation if there was a record of hospitalisation not resulting in delivery in the hospital abstracts database |
| Prenatal care | |||
| Prenatal care visit | During the pregnancy of the index child | Physician claims | A prenatal care visit was defined as the following physician tariff codes from the physician claims data: 8400 (complete prenatal assessment), 8401 (prenatal visits subsequent), 8501 (office visits, regional history and examination), 8507, 8509 (office visits), 8529 (regional intermediate visit or well baby care), 8540 (office visits complete history and physician examination, new patient), 8550 (consultation) |
| Late initiation of prenatal care | During the pregnancy of the index child | Physician claims | A woman was considered as having late initiation of prenatal care if she began care after the first trimester of pregnancy (date of conception—91 days). This was determined by assessing when the first prenatal care tariff date was |
| No care | During the pregnancy of the index child | Physician claims | A woman was considered as having no prenatal care if she had no visits with a prenatal care tariff during her pregnancy |
| Care initialised in first trimester | During the pregnancy of the index child | Physician claims | A woman was considered as having care initialised in the first trimester if her first prenatal visit was between the date of conception to 91 days |
| Care initialised in second trimester | During the pregnancy of the index child | Physician claims | A woman was considered as having care initialised in the second trimester if her first prenatal visit was between 92 to 189 days |
| Care initialised in third trimester | During the pregnancy of the index child | Physician claims | A woman was considered as having care initialised in the third trimester if her first prenatal visit was between 189 days to the birth of the child |
| Low number of prenatal visits | During the pregnancy of the index child | Physician claims | A woman was considered to have a low number of prenatal visits if she had less than five prenatal care visits as determined by counting the number of prenatal care tariffs she had during the pregnancy of the index child. |
| Quality of prenatal care by the R-GINDEX | During the pregnancy of the index child | Physician claims Hospital Abstracts | The adequacy of prenatal care was determined using the R-GINDEX (Revised-Graduated Prenatal Care Utilisation Index). The following three variables were calculated using hospital and physician claims data: (1) gestational age of the newborn, (2) the trimester that prenatal care began; (3) the total number of prenatal visits during the pregnancy.The G-INDEX classifies prenatal care into the following categories:
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