Administrative Characteristics of Comprehensive Prenatal Case Management Programs L. Michele Issel, Ph.D., R.N., Ruth A. Anderson, Ph.D., R.N., and Debra J. Kane, Ph.C., R.N. Abstract The purpose of this study was to examine comprehen- sive prenatal case management programs in terms of organiza- tional, program, and process characteristics. Data from 66programsurveysofgovernmentagencieswereused.Organiza- tional capacity was measured as extent of organizational change andextentofinteragencyagreements.Programdataincludedage andsizeoftheprogram,reasonsforhavingcasemanagement,and funding diversity. Process data were eight types of interventions. Themosthighlyratedreasonforhavingcasemanagementwas to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with otheragencieswererare.Agencieswithmoreinteragencycontacts reported higher levels of change in the case management depart- ment and turnover among mid-level managers. Older programs hadfeweremployees.Approximately49%ofclientcontactswere not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive case management. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal case management should focus on cross-level questions. Key words: Medicaid, prenatal, case management, interagency agreement, interventions, management. One approach to addressing the needs of high-risk pregnant women is comprehensive, community-based prenatal case management. In more than 42 states, Medicaid reimburses case management as an optional program that targets women at high risk for adverse pregnancy outcomes (U.S. General Accounting Office, 1994). Comprehensive case management, beneficial to vulnerable populations, has a long history in public health. Several studies have identified positive effects of comprehensive case management for pregnant women and infants (cf., Future of Children, 1999). It is a multidisci- plinary, community-based service designed to increase appropriate usage of health and social services through simultaneous attention to multiple medical and social problems of individuals and is done within a family and community context (Issel & Anderson, 1999). In one qualitative descriptive study of prenatal case management, case managers revealed that their work was more difficult when there was lack of teamwork, leader- ship, and training for case management (Issel, 1997). This suggests that understanding organizational and mana- gerial characteristics of comprehensive prenatal case management programs is an important antecedent to program improvement. In addition, attempts to replicate successful programs require knowledge about organiza- tional and managerial factors contributing to that success. Administration of health services plays a role in client outcomes (Anderson & McDaniel, 1999), L. Michele Issel is Clinical Assistant Professor, University of Illinois at Chicago, School of Public Health, Chicago, Illinois. Ruth A. Anderson, Associate Professor, Duke University, School of Nursing, Durham, North Carolina. Debra J. Kane is a Doctoral Candidate, University of Illinois at Chicago, School of Public Health, Chicago, Illinois. Address correspondence to L. Michele Issel, PhD, RN, Clinical Assistant Professor, University of Illinois at Chicago, School of Public Health (MC 923), 1603 W. Taylor Street, Chicago, IL 60612. E-mail: issel@uic.edu Public Health Nursing Vol. 20 No. 5, pp. 349–360 0737-1209/03/$15.00 Ó Blackwell Publishing, Inc. 349