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Lynch V, Clemans-Cope L. Initiation and Receipt of Medication for Opioid Use Disorder Among Adolescents and Young Adults in 4 State Medicaid Programs in 2018: Improving Medicaid Quality Metrics. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:434-445. [PMID: 38294428 DOI: 10.1177/29767342241227791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD). METHODS We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions. RESULTS Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states. CONCLUSIONS Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.
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Roux AM, Tao S, Marcus S, Lushin V, Shea LL. A national profile of substance use disorder among Medicaid enrollees on the autism spectrum or with intellectual disability. Disabil Health J 2022; 15:101289. [DOI: 10.1016/j.dhjo.2022.101289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
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Hwang SS, Liu CL, Yu Q, Cui X, Diop H. Risk factors for emergency room use and rehospitalization among opioid-exposed newborns in Massachusetts. Birth 2021; 48:26-35. [PMID: 32888362 DOI: 10.1111/birt.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the risk factors for receipt of emergency room (ER) care and rehospitalization among opioid-exposed newborns in Massachusetts. DESIGN/METHODS We analyzed two linked data sets from 2002 to 2010: (a) Massachusetts Pregnancy to Early Life Longitudinal Data System and (b) Massachusetts Bureau of Substance Abuse Services Management Information System. Generalized estimating equations were used to assess the independent association of maternal and infant characteristics with ER use and rehospitalization in the first year of life. RESULTS Four thousand and five hundred and twenty-four maternal-infant dyads affected by OUD were included in the analysis. In adjusted analysis, risk factors for receipt of ER care included Hispanic ethnicity (aOR 1.63 [95% CI 1.30-2.05]), lower education levels (aOR 1.54-1.69 [95% CI 1.12-2.31]), nonprivate insurance (aOR 1.44 [95% CI 1.11-1.86]), and presence of maternal chronic conditions (aOR 1.14 [95% CI 1.01-1.29]). Risk factors for rehospitalization included prematurity (aOR 1.44 [95% CI 1.14-1.82]), low birthweight (aOR 2.02 [95% CI 1.63-2.49]), and nonprivate insurance (aOR 1.58 [95% CI 1.13-2.22]). Prolonged infant birth hospitalization was protective against both ER use (aOR 0.84 [95% CI 0.73-0.96]) and rehospitalization (aOR 0.63 [95% CI 0.53-0.75]). CONCLUSIONS Clinical and sociodemographic characteristics are risk factors for receipt of ER care and rehospitalization among opioid-exposed newborns in Massachusetts.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Chia-Ling Liu
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Qi Yu
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Xiaohui Cui
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
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Lynch V, Clemans-Cope L, Howell E, Hill I. Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016. J Subst Abuse Treat 2020; 124:108265. [PMID: 33771273 DOI: 10.1016/j.jsat.2020.108265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Substance use disorder (SUD) during pregnancy increases risks of adverse outcomes for mothers and children. Because Medicaid covers about half of all births and maternal SUD is a costly problem, describing the timing of enrollment and health care that Medicaid-enrolled pregnant women with SUDs receive is critical to understanding gaps in the timeliness and specificity of SUD diagnosis and treatment for pregnant women with SUDs. We used linked maternal and infant Medicaid claims and enrollment data and infant birth records from three states (n=72,086 mother-infant dyads) to estimate the share of sample women diagnosed with a specified SUD (e.g., opioid use disorder) before or during the birth month, with a specified SUD after the birth month, and with only an unspecified SUD diagnosed (e.g., drug use disorder complicating pregnancy). We also examined the timing of first observed Medicaid enrollment, SUD diagnosis and treatment, and maternal and infant costs. In the 24 months surrounding birth, 3.6% of women had a specified SUD diagnosis first observed before or during the birth month, 1.7% had a specified SUD diagnosis first observed after the birth month, and 6.0% had an SUD diagnosis that was not specified. Most women with a specified SUD diagnosis were enrolled in Medicaid before or early in pregnancy and initiated prenatal care in the first or second trimester, yet nearly one-third of these women received their specified SUD diagnosis after the birth month. Less than two-thirds of women with a specified SUD diagnosis received any SUD treatment during the study period (59.9% among those identified before or during the birth month and 63.1% among those observed after the birth month), and women with an unspecified SUD were about half as likely to get treatment (28.6%). Among treated women, more than two-thirds had the first observed treatment in the same month as their first observed SUD diagnosis. Findings point to a critical need for interventions as well as substantial opportunities to improve the identification of substance use-related needs and provision of treatment among women who birth in Medicaid. Changes in Medicaid and other public policy to reduce disincentives for pregnant and parenting women to report substance use during medical visits and to increase providers' abilities and motivation to equitably screen for as well as treat women with SUDs before, during, and after pregnancy could improve outcomes for mothers and their children. Improvements in SUD diagnosis would also improve prevalence estimates of specific types of SUD, which could contribute to better Medicaid policies aimed at prevention and treatment.
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Affiliation(s)
- Victoria Lynch
- The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA.
| | - Lisa Clemans-Cope
- The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA
| | - Embry Howell
- The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA
| | - Ian Hill
- The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA
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Stein Y, Hwang S, Liu CL, Diop H, Wymore E. The Association of Concomitant Maternal Marijuana Use on Health Outcomes for Opioid Exposed Newborns in Massachusetts, 2003-2009. J Pediatr 2020; 218:238-242. [PMID: 31843217 DOI: 10.1016/j.jpeds.2019.10.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/26/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
This population-based study showed that maternal opioid plus marijuana use during pregnancy was associated with increased odds of prematurity and low birth weight but lower odds of neonatal abstinence syndrome and prolonged hospitalization compared with opioid exposure without marijuana use. Further research should evaluate the biologic mechanisms responsible for these outcomes.
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Affiliation(s)
- Yin Stein
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO.
| | - Sunah Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
| | - Chia-Ling Liu
- Massachusetts Department of Public Health, Boston, MA
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA
| | - Erica Wymore
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
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McCloskey L, Quinn E, Ameli O, Heeren T, Craig M, Lee-Parritz A, Iverson R, Jack B, Bernstein JA. Interrupting the Pathway from Gestational Diabetes Mellitus to Type 2 Diabetes: The Role of Primary Care. Womens Health Issues 2019; 29:480-488. [PMID: 31562051 DOI: 10.1016/j.whi.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our objective was to describe patient-, provider-, and health systems-level factors associated with likelihood of obtaining guideline-recommended follow-up to prevent or mitigate early-onset type 2 diabetes after a birth complicated by gestational diabetes mellitus (GDM). METHODS This study presents a retrospective cohort analysis of de-identified demographic and health care system characteristics, and clinical claims data for 12,622 women with GDM who were continuously enrolled in a large, national U.S. health plan from January 31, 2006, to September 30, 2012. Data were obtained from the OptumLabs Data Warehouse. We extracted 1) known predictors of follow-up (age, race, education, comorbidities, GDM severity); 2) novel factors that had potential as predictors (prepregnancy use of preventive measures and primary care, delivery hospital size); and 3) outcome variables (glucose testing within 1 and 3 years and primary care visit within 3 years after delivery). RESULTS Asian ethnicity, higher education, GDM severity, and delivery in a larger hospital predicted greater likelihood of post-GDM follow-up. Women with a prepregnancy primary care visit of any type were two to three times more likely to receive postpartum glucose testing and primary care at 1 year, and 3.5 times more likely to have obtained testing and primary care at 3 years after delivery. CONCLUSIONS A history of use of primary care services before a pregnancy complicated by GDM seems to enhance the likelihood of postdelivery surveillance and preventive care, and thus reduce the risk of undetected early-onset type 2 diabetes. An emphasis on promoting early primary care connections for women in their early reproductive years, in addition to its overall value, is a promising strategy for ensuring follow-up testing and care for women after complicated pregnancies that forewarn risk for later chronic illness. Health systems should focus on models of care that connect primary and reproductive/maternity care before, during, and long after pregnancies occur.
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Affiliation(s)
- Lois McCloskey
- Boston University School of Public Health, Boston, Massachusetts.
| | - Emily Quinn
- Boston University School of Public Health, Boston, Massachusetts
| | - Omid Ameli
- Boston University School of Public Health, Boston, Massachusetts; OptumLabs, Boston, Massachusetts
| | - Timothy Heeren
- Boston University School of Public Health, Boston, Massachusetts
| | - Myrita Craig
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Ronald Iverson
- Boston University School of Medicine, Boston, Massachusetts
| | - Brian Jack
- Boston University School of Medicine, Boston, Massachusetts
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Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
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Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013-2016. Drug Alcohol Depend 2019; 195:156-163. [PMID: 30677745 DOI: 10.1016/j.drugalcdep.2018.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. METHODS This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014-2015 (2013-2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). RESULTS In the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. CONCLUSIONS There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.
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Kotelchuck M, Cheng ER, Belanoff C, Cabral HJ, Babakhanlou-Chase H, Derrington TM, Diop H, Evans SR, Bernstein J. The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts. Matern Child Health J 2018; 21:893-902. [PMID: 27832443 DOI: 10.1007/s10995-016-2190-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.
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Affiliation(s)
- Milton Kotelchuck
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Erika R Cheng
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Taletha M Derrington
- Center on Education and Human Services, Education Division, SRI International, Menlo ParkCA, USA
| | - Hafsatou Diop
- Office of Data Translation, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
| | - Stephen R Evans
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Canan C, Polinski JM, Alexander GC, Kowal MK, Brennan TA, Shrank WH. Automatable algorithms to identify nonmedical opioid use using electronic data: a systematic review. J Am Med Inform Assoc 2018; 24:1204-1210. [PMID: 29016967 DOI: 10.1093/jamia/ocx066] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/05/2017] [Indexed: 01/05/2023] Open
Abstract
Objective Improved methods to identify nonmedical opioid use can help direct health care resources to individuals who need them. Automated algorithms that use large databases of electronic health care claims or records for surveillance are a potential means to achieve this goal. In this systematic review, we reviewed the utility, attempts at validation, and application of such algorithms to detect nonmedical opioid use. Materials and Methods We searched PubMed and Embase for articles describing automatable algorithms that used electronic health care claims or records to identify patients or prescribers with likely nonmedical opioid use. We assessed algorithm development, validation, and performance characteristics and the settings where they were applied. Study variability precluded a meta-analysis. Results Of 15 included algorithms, 10 targeted patients, 2 targeted providers, 2 targeted both, and 1 identified medications with high abuse potential. Most patient-focused algorithms (67%) used prescription drug claims and/or medical claims, with diagnosis codes of substance abuse and/or dependence as the reference standard. Eleven algorithms were developed via regression modeling. Four used natural language processing, data mining, audit analysis, or factor analysis. Discussion Automated algorithms can facilitate population-level surveillance. However, there is no true gold standard for determining nonmedical opioid use. Users must recognize the implications of identifying false positives and, conversely, false negatives. Few algorithms have been applied in real-world settings. Conclusion Automated algorithms may facilitate identification of patients and/or providers most likely to need more intensive screening and/or intervention for nonmedical opioid use. Additional implementation research in real-world settings would clarify their utility.
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Affiliation(s)
- Chelsea Canan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | | | - William H Shrank
- University of Pittsburgh Medical Center Health Plan, Pittsburgh, PA, USA
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Huỳnh C, Rochette L, Pelletier É, Lesage A. Définir les troubles liés aux substances psychoactives à partir de données
administratives. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1058609ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hwang SS, Diop H, Liu CL, Yu Q, Babakhanlou-Chase H, Cui X, Kotelchuck M. Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010. J Pediatr 2017; 191:69-75. [PMID: 29050752 DOI: 10.1016/j.jpeds.2017.08.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/18/2017] [Accepted: 08/16/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the association of maternal substance use disorders (SUDs) during pregnancy with adverse neonatal outcomes and infant hospital re-admissions, observational stays, and emergency department utilization in the first year of life. STUDY DESIGN We analyzed 2 linked statewide datasets from 2002 to 2010: the Massachusetts Pregnancy to Early Life Longitudinal data system and the Massachusetts Bureau of Substance Abuse Services Management Information System. Generalized estimating equations were used to assess the association of maternal SUDs and neonatal outcomes and infant hospital-based care in the first year of life, controlling for maternal and infant characteristics. RESULTS Maternal SUDs increased from 19.4 per 1000 live births in 2003 to 31.1 per 1000 live births in 2009. In the adjusted analysis, exposed neonates were more likely to be born preterm (aOR 1.85; 95% CI 1.75-1.96) and low birthweight (aOR 1.94; 95% CI 1.80-2.09). After controlling for maternal characteristics and preterm birth, SUD-exposed neonates were more likely to have intrauterine growth restriction, cardiac, respiratory, neurologic, infectious, hematologic, and feeding/nutrition problems, prolonged hospital stay, and higher mortality (aOR range 1.26-3.80). Exposed infants were more likely to be rehospitalized (aOR 1.10; 95% CI 1.04-1.17) but less likely to have an observational stay (aOR 0.90; 95% CI 0.82-0.99) or use the emergency department (aOR 0.87; 95% CI 0.83-0.90) in the first year of life. CONCLUSIONS Infants born to mothers with SUD are at higher risk for adverse health outcomes in the perinatal period and are also more likely to be rehospitalized in the first year of life.
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Affiliation(s)
- Sunah S Hwang
- Department of Neonatology, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Hafsatou Diop
- Office of Data Translation, Massachusetts Department of Public Health, Boston, MA
| | - Chia-Ling Liu
- Office of Data Translation, Massachusetts Department of Public Health, Boston, MA
| | - Qi Yu
- Office of Data Translation, Massachusetts Department of Public Health, Boston, MA
| | | | - Xiaohui Cui
- Office of Data Translation, Massachusetts Department of Public Health, Boston, MA
| | - Milton Kotelchuck
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, MA
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Bernstein JA, Quinn E, Ameli O, Craig M, Heeren T, Lee-Parritz A, Iverson R, Jack B, McCloskey L. Follow-up after gestational diabetes: a fixable gap in women's preventive healthcare. BMJ Open Diabetes Res Care 2017; 5:e000445. [PMID: 28948028 PMCID: PMC5595177 DOI: 10.1136/bmjdrc-2017-000445] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/21/2017] [Accepted: 08/16/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a known harbinger of future type 2 diabetes mellitus (T2DM), hypertension, and cardiac disease. This population-based study was designed to identify gaps in follow-up care relevant to prevention of T2DM in a continuously insured sample of women diagnosed with GDM. RESEARCH DESIGN AND METHODS We analyzed data spanning 2005-2015 from OptumLabs Data Warehouse, a comprehensive, longitudinal, real-world data asset with deidentified lives across claims and clinical information, to describe patterns of preventive care after GDM. Women with GDM were followed, from 1 year preconception through 3 years postdelivery to identify individual and healthcare systems characteristics, and report on GDM-related outcomes: postpartum glucose testing, transition to primary care for monitoring, GDM recurrence, and T2DM onset. RESULTS Among 12 622 women with GDM, we found low rates of glucose monitoring in the recommended postpartum period (5.8%), at 1 year (21.8%), and at 3 years (51%). A minority had contact with primary care postdelivery (5.7% at 6 months, 13.2% at 1 year, 40.5% at 3 years). Despite increased population risk (GDM recurrence in 52.2% of repeat pregnancies, T2DM onset within 3 years in 7.6% of the sample), 70.1% of GDM-diagnosed women had neither glucose testing nor a primary care visit at 1 year and 32.7% had neither at 3 years. CONCLUSIONS We found low rates of glucose testing and transition to primary care in this group of continuously insured women with GDM. Despite continuous insurance coverage, many women with a pregnancy complication that portends risk for future chronic illness fail to obtain follow-up testing and may have difficulty navigating between clinician specialties. Results point to a need for action to close the gap between obstetrics and primary care to ensure receipt of preventive monitoring as recommended by both the American Diabetes Association and the American Congress of Obstetricians and Gynecologists.
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Affiliation(s)
- Judith Apt Bernstein
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily Quinn
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Omid Ameli
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- OptumLabs OLDW, Boston, Massachusetts, USA
| | - Myrita Craig
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy Heeren
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Aviva Lee-Parritz
- Department of Obstetrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ronald Iverson
- Department of Obstetrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian Jack
- Department of Obstetrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lois McCloskey
- Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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15
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Putnam-Hornstein E, Prindle JJ, Leventhal JM. Prenatal Substance Exposure and Reporting of Child Maltreatment by Race and Ethnicity. Pediatrics 2016; 138:peds.2016-1273. [PMID: 27519445 DOI: 10.1542/peds.2016-1273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Substance exposure is thought to contribute to reports of suspected maltreatment made to child protective services (CPS) at or shortly after birth. There are limited data, however, on whether clinicians are more likely to report black and Hispanic substance-exposed infants compared with white infants. METHODS We examined racial differences in diagnosed substance exposure and subsequent maltreatment reports by using linked birth, hospital discharge, and CPS records. Diagnostic codes were used to document substance exposure; CPS records provided information on maltreatment reports. Prevalence of infant exposure was calculated by race or ethnicity, substance type, and sociodemographic covariates. We estimated racial differences in maltreatment reporting among substance-exposed infants using multivariable models. RESULTS In a 2006 population-based California birth cohort of 474 071 black, Hispanic, and white infants, substance exposure diagnoses were identified for 1.6% of infants (n = 7428). Exposure varied significantly across racial groups (P < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most frequently observed substances were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for sociodemographic and pregnancy factors, we found that substance-exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance-exposed white infants. CONCLUSIONS Although we were unable to address potential racial and ethnic disparities in screening for substances at birth, we found no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure.
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Affiliation(s)
- Emily Putnam-Hornstein
- Department of Children, Youth, and Families, School of Social Work, University of Southern California, Los Angeles, California; and
| | - John J Prindle
- Department of Children, Youth, and Families, School of Social Work, University of Southern California, Los Angeles, California; and
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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16
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Gibberd AJ, Simpson JM, Eades SJ. No official identity: a data linkage study of birth registration of Aboriginal children in Western Australia. Aust N Z J Public Health 2016; 40:388-94. [DOI: 10.1111/1753-6405.12548] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/01/2015] [Accepted: 03/01/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Judy M. Simpson
- School of Public Health; University of Sydney; New South Wales
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