1
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Damodaran K, Brumberg HL, Jawale N, Giblin C, Shah S. Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health. J Perinatol 2024; 44:488-492. [PMID: 38082070 DOI: 10.1038/s41372-023-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To determine the association between maternal health insurance type and birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health. DESIGN/METHODS A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI). RESULTS 1015 mothers [M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI. CONCLUSIONS M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.
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Affiliation(s)
- Kriti Damodaran
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Heather L Brumberg
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Nilima Jawale
- Division of Neonatology, UHS, Binghamton General Hospital, Binghamton, NY, USA
| | - Clare Giblin
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Shetal Shah
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
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Osei L, Vignier N, Nacher M, Laumonnier J, Conan C, Clarke L, Koivogui A, Covis S, Valony L, Basurko C, Wiedner-Papin S, Prual A, Cardoso T, Leneuve-Dorilas M, Alcouffe L, Hcini N, Bernard S, Succo T, Vendittelli F, Elenga N. Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention. Int J Public Health 2024; 69:1606423. [PMID: 38681119 PMCID: PMC11048969 DOI: 10.3389/ijph.2024.1606423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/06/2024] [Indexed: 05/01/2024] Open
Abstract
Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.
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Affiliation(s)
- Lindsay Osei
- Department of Pediatrics, Cayenne Hospital, Cayenne, French Guiana
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Collectivité Territoriale de Guyane, Cayenne, French Guiana
| | - Nicolas Vignier
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Avicenne Hospital, Assistance Publique—Hôpitaux de Paris, Department of Infectious and Tropical Diseases, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution, Inserm Unité Mixte de Recherche 1137, Université Sorbonne Paris Nord, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Paris, France
| | - Mathieu Nacher
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Claude Conan
- Caisse Générale de Sécurité Sociale, Cayenne, French Guiana
| | | | - Akoï Koivogui
- Centre Régional de Coordination des Dépistages des Cancers Ile-de-France, Bondy, France
| | - Sabrina Covis
- Collectivité Territoriale de Guyane, Cayenne, French Guiana
| | - Luciano Valony
- Institut National des Statistiques et Études Économiques, Cayenne, French Guiana
| | - Célia Basurko
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
| | | | - Alain Prual
- Collectivité Territoriale de Mayotte, Mamoudzou, Mayotte
| | | | - Malika Leneuve-Dorilas
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- Réseau Perinat Guyane, Cayenne, French Guiana
| | - Leslie Alcouffe
- Centre d’Investigation Clinique Antilles Guyane, INSERM, Centre d’Investigation Clinique 1424, Cayenne Hospital, Cayenne, French Guiana
- COREVIH Guyane, Cayenne Hospital, Cayenne, French Guiana
| | - Najeh Hcini
- Department of Obstetrics, Saint-Laurent-du-Maroni Hospital, Saint-Laurent-du-Maroni, French Guiana
| | | | - Tiphanie Succo
- Santé Publique France Regional Unit, Cayenne, French Guiana
| | - Françoise Vendittelli
- Université Clermont Auvergne, Centre Hospitalier Universitaire Clermont-Ferrand, Centre National de la Recherche Scientifique, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- Audipog, Université Claude Bernard Lyon 1, Lyon, France
| | - Narcisse Elenga
- Department of Pediatrics, Cayenne Hospital, Cayenne, French Guiana
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Williams VN, Marshall J, Richey M, Allison M. Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method. Matern Child Health J 2024; 28:333-343. [PMID: 37989933 DOI: 10.1007/s10995-023-03839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021. OBJECTIVE To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida. METHODS This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation. RESULTS Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes. CONCLUSIONS FOR PRACTICE Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Jennifer Marshall
- University of South Florida, College of Public Health, Tampa, FL, 33612, USA
| | - Mirine Richey
- Center for Prevention & Early Intervention Policy, Florida State University, Tallahassee, FL, 32301, USA
| | - Mandy Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Children's Hospital Colorado, Aurora, CO, USA
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Tsapatsaris A, Bhima M, Sekhar TC. Regarding "Burden of Comorbidities and Healthcare Resource Utilization Among Medicaid-Enrolled Extremely Premature Infants". JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:77-79. [PMID: 37033150 PMCID: PMC10076213 DOI: 10.36469/001c.73989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
In their article, Mowitz et al investigated the burden of comorbidities and healthcare resource utilization among extremely premature infants enrolled in Medicaid, laying a foundation for further policy action.
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Affiliation(s)
- Ava Tsapatsaris
- Gallatin School of Individualized Study New York University, New York, NY
| | - Miran Bhima
- Trinity College of Arts and Sciences Duke University, Durham, North Carolina
| | - Tejas C Sekhar
- Division of Pulmonary and Critical Care Medicine Washington University School of Medicine, St. Louis, Missouri
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Mendrinos A, Ramesh B, Ruktanonchai CW, Gohlke JM. Poultry Concentrated Animal-Feeding Operations on the Eastern Shore, Virginia, and Geospatial Associations with Adverse Birth Outcomes. Healthcare (Basel) 2022; 10:healthcare10102016. [PMID: 36292462 PMCID: PMC9602095 DOI: 10.3390/healthcare10102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
Concentrated animal-feeding operations (CAFOs) emit pollution into surrounding areas, and previous research has found associations with poor health outcomes. The objective of this study was to investigate if home proximity to poultry CAFOs during pregnancy is associated with adverse birth outcomes, including preterm birth (PTB) and low birth weight (LBW). This study includes births occurring on the Eastern Shore, Virginia, from 2002 to 2015 (N = 5768). A buffer model considering CAFOs within 1 km, 2 km, and 5 km of the maternal residence and an inverse distance weighted (IDW) approach were used to estimate proximity to CAFOs. Associations between proximity to poultry CAFOs and adverse birth outcomes were determined by using regression models, adjusting for available covariates. We found a −52.8 g (−95.8, −9.8) change in birthweight and a −1.51 (−2.78, −0.25) change in gestational days for the highest tertile of inverse distance to CAFOs. Infants born with a maternal residence with at least one CAFO within a 5 km buffer weighed −47 g (−94.1, −1.7) less than infants with no CAFOs within a 5 km buffer of the maternal address. More specific measures of exposure pathways via air and water should be used in future studies to refine mediators of the association found in the present study.
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Affiliation(s)
- Antonia Mendrinos
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Balaji Ramesh
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Corrine W. Ruktanonchai
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
| | - Julia M. Gohlke
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA
- Correspondence:
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Raffo JE, Titcombe C, Henning S, Meghea CI, Strutz KL, Roman LA. Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting. Womens Health Issues 2021; 31:532-539. [PMID: 34301450 DOI: 10.1016/j.whi.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To better address physical, emotional, and social needs of Medicaid-insured pregnant women, a Federally Qualified Health Center and a hospital-based obstetrics and gynecology residency practice collaborated with their agency-based state Medicaid-sponsored home visiting program, the Maternal Infant Health Program (MIHP). In partnership, both practice sites created patient standards of care to identify and engage eligible pregnant women into underutilized home visiting services for enhanced prenatal care coordination. The purpose of this study was to describe how each practice operationalized clinical-community linkage strategies that best suited their setting and to determine if efforts resulted in improved MIHP participation and other service use. METHODS Using linked administrative data, a quasi-experimental pre-post difference-in-difference design was used to examine changes in MIHP participation, adequate prenatal care, emergency department use, and postpartum care among patients in each practice compared with the same birth cohorts between 2010 and 2015 in the rest of the state. RESULTS When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1-10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4-14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3-5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3-14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed. CONCLUSIONS Clinical-community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical-community linkages.
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Affiliation(s)
- Jennifer E Raffo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan.
| | | | - Susan Henning
- Spectrum Health, Healthier Communities, Grand Rapids, Michigan
| | - Cristian I Meghea
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
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7
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Izadirad H, Zareban I, Niknami S, Atashpanjeh A. Factors affecting pregnancy care and birth weight among pregnant women in Baluchestan, Iran: an application of the social cognitive theory. Women Health 2021; 61:510-519. [PMID: 34016032 DOI: 10.1080/03630242.2021.1919282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to determine the effects of self-efficacy, social support, and health literacy on prenatal care and birth weight among pregnant women. This descriptive-analytical study was conducted on 860 primiparous pregnant women who referred to health care centers for prenatal care in Iranshahr, Iran. Participants were selected through a two-stage cluster sampling. The data were collected from November 2016 to the end of January 2017 using a valid and reliable questionnaire. Data were analyzed using descriptive tests, chi-square and hierarchical regression analyses in SPSS 20. The findings indicated that health literacy, self-efficacy, income, social support, and education level explained for 7.5%, 4.6%, 2.6%, 1%, and 0.6% of the variances in caring prenatal care, respectively. Moreover, income, prenatal care, insurance, health literacy, and social support were the most effective on birth weight outcome (OR = 2.21, OR = 2.12, OR = 2, OR = 0.66, OR = 0.17). The results of the current study indicated that a combination of health literacy, self-efficacy, and social support are necessary to improve prenatal care and birth weight for Iranian low-income pregnant women.
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Affiliation(s)
- Hossien Izadirad
- Zahedan Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Iraj Zareban
- Zahedan Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shamsoddin Niknami
- Department of Health Education, School of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Alireza Atashpanjeh
- Clinical Immunology Research Center, ELT Department, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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8
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Peahl AF, Howell JD. The evolution of prenatal care delivery guidelines in the United States. Am J Obstet Gynecol 2021; 224:339-347. [PMID: 33316276 PMCID: PMC9745905 DOI: 10.1016/j.ajog.2020.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 pandemic led to some of the most drastic changes in clinical care delivery ever seen in the United States. Almost overnight, providers of prenatal care adopted virtual visits and reduced visit schedules. These changes stood in stark contrast to the 12 to 14 in-person prenatal visit schedule that had been previously recommended for almost a century. As maternity care providers consider what prenatal care delivery changes we should maintain following the acute pandemic, we may gain insight from understanding the evolution of prenatal care delivery guidelines. In this paper, we start by sketching out the relatively unstructured beginnings of prenatal care in the 19th century. Most medical care fell within the domain of laypeople, and childbirth was a central feature of female domestic culture. We explore how early discoveries about "toxemia" created the groundwork for future prenatal care interventions, including screening of urine and blood pressure-which in turn created a need for routine prenatal care visits. We then discuss the organization of the medical profession, including the field of obstetrics and gynecology. In the early 20th century, new data increasingly revealed high rates of both infant and maternal mortalities, leading to a greater emphasis on prenatal care. These discoveries culminated in the first codification of a prenatal visit schedule in 1930 by the Children's Bureau. Surprisingly, this schedule remained essentially unchanged for almost a century. Through the founding of the American College of Obstetricians and Gynecologists, significant technological advancements in laboratory testing and ultrasonography, and calls of the National Institutes of Health Task Force for changes in prenatal care delivery in 1989, prenatal care recommendations continued to be the same as they had been in 1930-monthly visits until 28 weeks' gestation, bimonthly visits until 36 weeks' gestation, and weekly visits until delivery. However, coronavirus disease 2019 forced us to change, to reconsider both the need for in-person visits and frequency of visits. Currently, as we transition from the acute pandemic, we should consider how to use what we have learned in this unprecedented time to shape future prenatal care. Lessons from a century of prenatal care provide valuable insights to inform the next generation of prenatal care delivery.
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
| | - Joel D Howell
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Departments of Internal Medicine and History, University of Michigan, Ann Arbor, MI
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9
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Disparities in infant mortality by payment source for delivery in the United States. Prev Med 2021; 145:106361. [PMID: 33309872 DOI: 10.1016/j.ypmed.2020.106361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/13/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In this study, we hypothesized that infant mortality varies among health insurance status. Furthermore, we examined whether there are racial and ethnic disparities in the association between infant death and payment source for delivery. Our study used US national linked birth and infant death data for 2013 and 2017 collected by the National Center for Health Statistics and included 3,311,504 and 3,218,168 live births for each year. The principal source of payment for delivery was classified into three groups: Medicaid, private insurance, and self-payment. The outcome measures were infant mortality, neonatal mortality, and postneonatal mortality. Subgroup analysis for race and ethnicity was also performed. Overall infant mortality was lower in mothers who paid with private insurance than in those who paid with Medicaid insurance (RR = 0.87, 95% CI 0.84-0.90 in 2013; RR = 0.91, 95% CI 0.87-0.94 in 2017), but it was higher in self-paid women than in Medicaid-insured women at delivery (RR = 1.25, 95% CI 1.17-1.33 in 2013; RR = 1.16, 95% CI 1.08-1.24 in 2017). Non-Hispanic black (RR = 1.67, 95% CI 1.47-1.90 in 2013; RR = 1.16, 95% CI 1.00-1.35 in 2017) and Hispanic (RR = 1.30, 95% CI 1.17-1.44 in 2013; RR = 1.22, 95% CI 1.09-1.36 in 2017) mothers with self-payment had a higher risk for infant mortality than those with Medicaid at delivery. Newborns whose mothers have no health insurance would be more vulnerable to infant mortality than Medicaid beneficiaries, and non-white ethnic groups with self-payment would have an elevated risk of infant mortality among other racial and ethnic groups.
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10
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Maternal proximity to Central Appalachia surface mining and birth outcomes. Environ Epidemiol 2021; 5:e128. [PMID: 33778360 PMCID: PMC7939414 DOI: 10.1097/ee9.0000000000000128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content is available in the text. Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure.
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Dubay L, Hill I, Garrett B, Blavin F, Johnston E, Howell E, Morgan J, Courtot B, Benatar S, Cross-Barnet C. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of ‘Strong Start For Mothers And Newborns’. Health Aff (Millwood) 2020; 39:1042-1050. [DOI: 10.1377/hlthaff.2019.01042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lisa Dubay
- Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Ian Hill
- Ian Hill is a senior fellow in the Health Policy Center, Urban Institute
| | - Bowen Garrett
- Bowen Garrett is a senior fellow in the Health Policy Center, Urban Institute
| | - Fredric Blavin
- Fredric Blavin is a principal research associate in the Health Policy Center, Urban Institute
| | - Emily Johnston
- Emily Johnston is a research associate in the Health Policy Center, Urban Institute
| | - Embry Howell
- Embry Howell is a nonresident fellow in the Health Policy Center, Urban Institute
| | - Justin Morgan
- Justin Morgan is a PhD student at the Harvard T. H. Chan School of Public Health. At the time this research was conducted, he was a research analyst at the Urban Institute
| | - Brigette Courtot
- Brigette Courtot is a principal research associate in the Health Policy Center, Urban Institute
| | - Sarah Benatar
- Sarah Benatar is a principal research associate in the Health Policy Center, Urban Institute
| | - Caitlin Cross-Barnet
- Caitlin Cross-Barnet is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
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Harvey SM, Oakley LP, Yoon J, Luck J. Coordinated Care Organizations: Neonatal and Infant Outcomes in Oregon. Med Care Res Rev 2017; 76:627-642. [PMID: 29161977 DOI: 10.1177/1077558717741980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2012, Oregon's Medicaid program implemented a comprehensive accountable care model delivered through coordinated care organizations (CCOs). Because CCOs are expected to improve utilization of services and health outcomes, neonatal and infant outcomes may be important indicators of their impact. Estimating difference-in-differences models, we compared prepost CCO changes in outcomes (e.g., low birth weight, abnormal conditions, 5-minute Apgar score, congenital anomalies, and infant mortality) between Medicaid and non-Medicaid births among 99,924 infants born in Oregon during 2011 and 2013. We further examined differences in the impact of CCOs by ethnicity and rurality. Following CCO implementation the likelihood of low birth weight and abnormal conditions decreased by 0.95% and 1.08%, a reduction of 13.4% and 10.4% compared with the pre-CCO level for Medicaid enrollees, respectively. These reductions could be predictive of lifelong health benefits for infants and lower costs for acute care and are, therefore, important markers of success for the CCO model.
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Affiliation(s)
| | | | - Jangho Yoon
- 1 Oregon State University, Corvallis, OR, USA
| | - Jeff Luck
- 1 Oregon State University, Corvallis, OR, USA
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13
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Vohr B, McGowan E, Keszler L, Alksninis B, O'Donnell M, Hawes K, Tucker R. Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants. J Pediatr 2017; 181:86-92.e1. [PMID: 27817878 DOI: 10.1016/j.jpeds.2016.10.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization. STUDY DESIGN In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization. RESULTS In bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non-English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%). CONCLUSIONS Transition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.
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Affiliation(s)
- Betty Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI.
| | - Elisabeth McGowan
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | - Lenore Keszler
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | - Barbara Alksninis
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Melissa O'Donnell
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Katheleen Hawes
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
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Markus AR, Krohe S, Garro N, Gerstein M, Pellegrini C. Examining the association between Medicaid coverage and preterm births using 2010–2013 National Vital Statistics Birth Data. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/10796126.2016.1254601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anne Rossier Markus
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Maya Gerstein
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Improving Medicaid: three decades of change to better serve women of childbearing age. Clin Obstet Gynecol 2016; 58:336-54. [PMID: 25860326 DOI: 10.1097/grf.0000000000000115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Over the past 3 decades, major changes enhanced Medicaid's role in improving the health of women and perinatal outcomes. Reforms in the 1980s and 1990s had impact not only on coverage but also on current policy debates. Whether or not states expand eligibility under the Affordable Care Act, Medicaid is important. Increased coverage for well-woman visits, preconception care, and contraceptive methods are opportunities in gynecology. As a critical source of maternity coverage, Medicaid can improve prenatal care, reduce preterm births, limit early elective deliveries, and increase postpartum visits. Obstetrician-gynecologists play a role in translating coverage into access to quality services.
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Fernandez Turienzo C, Sandall J, Peacock JL. Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis. BMJ Open 2016; 6:e009044. [PMID: 26758257 PMCID: PMC4716175 DOI: 10.1136/bmjopen-2015-009044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of models of antenatal care designed to prevent and reduce preterm birth (PTB) in pregnant women. METHODS We conducted a search of seven electronic databases and reference lists of retrieved studies to identify trials from inception up to July 2014 where pregnant women, regardless of risk factors for pregnancy complications, were randomly allocated to receive an alternative model of antenatal care or routine care. We pooled risks of PTB to determine the effect of alternative care models in all pregnant women. We also assessed secondary maternal and infant outcomes, women's satisfaction and economic outcomes. RESULTS 15 trials involving 22,437 women were included. Pregnant women in alternative care models were less likely to experience PTB (risk ratio 0.84, 95% CI 0.74 to 0.96). The subgroup of women randomised to midwife-led continuity models of antenatal care were less likely to experience PTB (0.78, 0.66 to 0.91) but there was no significant difference between this group and women allocated to specialised care (0.92, 0.76 to 1.12) (interaction test for subgroup differences p=0.20). Overall low-risk women in alternative care models were less likely to have PTB (0.74, 0.59 to 0.93), but this effect was not significantly different from that in mixed-risk populations (0.91, 0.79 to 1.05) (subgroup p=0.13). CONCLUSIONS Alternative models of antenatal care for all pregnant women are effective in reducing PTB compared with routine care, but no firm conclusions could be drawn regarding the relative benefits of the two models. Future research should evaluate the impact of antenatal care models which include more recent interventions and predictive tests, and which also offer continuity of care by midwives throughout pregnancy. PROSPERO REGISTRATION NUMBER CRD42014007116.
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Affiliation(s)
| | - Jane Sandall
- Division of Women's Health, Faculty of Life Sciences & Medicine, King's College London, Women's Health Academic Centre, St Thomas' Hospital,, London, UK
| | - Janet L Peacock
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Goyal NK, Hall ES, Greenberg JM, Kelly EA. Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population. J Womens Health (Larchmt) 2015; 24:681-8. [PMID: 26102375 DOI: 10.1089/jwh.2014.5069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite prior efforts to develop pregnancy risk prediction models, there remains a lack of evidence to guide implementation in clinical practice. The current aim was to develop and validate a risk tool grounded in social determinants theory for use among at-risk Medicaid patients. METHODS This was a retrospective cohort study of 409 women across 17 Cincinnati health centers between September 2013 and April 2014. The primary outcomes included preterm birth, low birth weight, intrauterine fetal demise, and neonatal death. After random allocation into derivation and validation samples, a multivariable model was developed, and a risk scoring system was assessed and validated using area under the receiver operating characteristic curve (AUROC) values. RESULTS The derived multivariable model (n=263) included: prior preterm birth, interpregnancy interval, late prenatal care, comorbid conditions, history of childhood abuse, substance use, tobacco use, body mass index, race, twin gestation, and short cervical length. Using a weighted risk score, each additional point was associated with an odds ratio of 1.57 for adverse outcomes, p<0.001, AUROC=0.79. In the validation sample (n=146), each additional point conferred an odds ratio of 1.20, p=0.03, AUROC=0.63. Using a cutoff of 20% probability for the outcome, sensitivity was 29%, with specificity 82%. Positive and negative predictive values were 22% and 85%, respectively. CONCLUSIONS Risk scoring based on social determinants can discriminate pregnancy risk within a Medicaid population; however, performance is modest and consistent with prior prediction models. Future research is needed to evaluate whether implementation of risk scoring in Medicaid prenatal care programs improves clinical outcomes.
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Affiliation(s)
- Neera K Goyal
- 1 Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Eric S Hall
- 1 Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - James M Greenberg
- 1 Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Elizabeth A Kelly
- 2 Department of Obstetrics and Gynecology, University of Cincinnati , Cincinnati, Ohio
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Seravalli L, Patterson F, Nelson DB. Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women. J Midwifery Womens Health 2014; 59:374-9. [PMID: 24890400 PMCID: PMC4115024 DOI: 10.1111/jmwh.12088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. METHODS Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. RESULTS Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P < .001). DISCUSSION Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth.
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Identifying Multiple Risks of Low Birth Weight Using Person-Centered Modeling. Womens Health Issues 2014; 24:e251-6. [DOI: 10.1016/j.whi.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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20
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Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Matern Child Health J 2013; 17:1518-25. [PMID: 23065298 PMCID: PMC4039287 DOI: 10.1007/s10995-012-1162-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.
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Affiliation(s)
- Shun Zhang
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Kathryn Cardarelli
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ruth Shim
- Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jiali Ye
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Karla L. Booker
- Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - George Rust
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
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Bronstein JM, Ounpraseuth S, Jonkman J, Fletcher D, Nugent RR, McGhee J, Lowery CL. Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention. Med Care Res Rev 2012; 69:699-720. [PMID: 22951314 DOI: 10.1177/1077558712458157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities. Local physician use of a Call Center service was also associated with patient specialty contact. Expansion of telemedicine remote sites did not increase the likelihood of contact but was associated with the shift toward remote modalities. Specialty consult use and modality were influenced by the care context of the patient, particularly level of pregnancy risk, the specialty of the primary prenatal care provider, the timing of her prenatal care, and her ethnicity and education level.
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Affiliation(s)
- Janet M Bronstein
- School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
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Krans EE, Davis MM. Preventing Low Birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. Am J Obstet Gynecol 2012; 206:398-403. [PMID: 21889122 DOI: 10.1016/j.ajog.2011.06.082] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/14/2011] [Accepted: 06/22/2011] [Indexed: 11/20/2022]
Abstract
In 2010, Preventing Low Birthweight celebrated it 25th anniversary. The report, one of the most influential policy statements ever issued regarding obstetric health care delivery, linked prenatal care to a reduction in low birthweight (LBW). Medicaid coverage for prenatal care services was subsequently expanded and resulted in increased prenatal care utilization. However, the rate of LBW failed to decrease. This well-intentioned expansion of prenatal care services did not change the structure of prenatal care. A single, standardized prenatal care model, largely ineffective in the prevention of LBW, was expanded to a heterogeneous group of patients with a variety of medical and psychosocial risk factors. Reinventing prenatal care as a flexible model, with content, frequency, and timing tailored to maternal and fetal risk, may improve adverse birth outcomes. Risk-appropriate prenatal care may improve the effectiveness of prenatal care for high-risk patients and the efficiency of prenatal care delivery for low-risk patients.
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Affiliation(s)
- Elizabeth E Krans
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109-5604, USA.
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Evaluating the effect of hospital and insurance type on the risk of 1-year mortality of very low birth weight infants: controlling for selection bias. Med Care 2012; 50:353-60. [PMID: 22422056 DOI: 10.1097/mlr.0b013e318245a128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias. METHODS The study population was limited to singleton live birth infants having birth weight between 500 and 1500 g with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. In addition, a conventional multivariable logistic regression model was used for comparison purposes. RESULTS Generally, all 3 analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat. Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap confidence interval, 18.5%-48.9%) in the risk of 1-year mortality as compared with those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap confidence interval, 11-32), would need to be delivered at a hospital with an NICU to prevent 1 additional death at 1 year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non-Medicaid-insured women. CONCLUSIONS Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital.
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Choté AA, Koopmans GT, Redekop WK, de Groot CJM, Hoefman RJ, Jaddoe VWV, Hofman A, Steegers EAP, Mackenbach JP, Trappenburg M, Foets M. Explaining ethnic differences in late antenatal care entry by predisposing, enabling and need factors in The Netherlands. The Generation R Study. Matern Child Health J 2011; 15:689-99. [PMID: 20533083 PMCID: PMC3131512 DOI: 10.1007/s10995-010-0619-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57–1.58), Cape Verdean (OR = 1.65. CI: 0.96–2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07–2.85; Dutch Antillean OR 1.80, CI: 1.04–3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.
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Affiliation(s)
- A A Choté
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Cluss PA, Levine MD, Landsittel D. The Pittsburgh STOP program: disseminating an evidence-informed intervention for low-income pregnant smokers. Am J Health Promot 2011; 25:S75-81. [PMID: 21510791 PMCID: PMC3677550 DOI: 10.4278/ajhp.100616-quan-197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers. SETTING STOP is delivered in community health care clinics serving economically disadvantaged women. PARTICIPANTS Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured. METHODS An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression. RESULTS Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mother's age, nicotine dependence, and number of sessions attended. LIMITATIONS STOP is a community program with self-selected participants and no control group. CONCLUSION Low-income pregnant smokers will engage in an evidence-informed cessation program tailored for this group, with quit rates that compare to controlled research results.
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Affiliation(s)
- Patricia A Cluss
- Western Psychiatric Institute & Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Anum EA, Retchin SM, Garland SL, Strauss JF. Medicaid and preterm births in Virginia: an analysis of recent outcomes. J Womens Health (Larchmt) 2010; 19:1969-75. [PMID: 20831442 DOI: 10.1089/jwh.2010.1955] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The study objectives were to evaluate adequacy of prenatal care and risk for preterm birth among Medicaid clients in Virginia and to determine if payment method is associated with the risk of preterm birth. METHODS Birth certificate data for the Commonwealth of Virginia for 2007 and 2008 were linked with Medicaid claims data. Analysis was limited to singleton births. Three payment methods were evaluated: private insurance, self-pay, and Medicaid. The prevalence of preterm birth for each level of prenatal care defined by the Kotelchuck prenatal care index was assessed for each payment method. Unconditional logistic regression modeling was used to assess the association between payment method and preterm birth risk while controlling for known preterm birth risk factors. RESULTS Preterm birth prevalences (95% confidence interval [CI]) for the different payment methods were 7.9% (4.79-8.07) for the privately insured, 10.1% (9.57-10.60) for the self-pay group, and 10.2% (9.95-10.45) for Medicaid recipients. Compared with those with private insurance, women on Medicaid had an adjusted odds ratio (OR) for preterm birth (95% CI) of 0.99 (0.94-1.03). Self-pay mothers had a 32% increase in the odds of preterm birth relative to the privately insured. All payment groups show a trend toward significant reduction in preterm birth prevalence as adequacy of prenatal care improved from inadequate to adequate. Medicaid enrollees had a high prevalence of known risk factors, including smoking and illicit drug use and cervical insufficiency. CONCLUSIONS When known risk factors have been controlled, preterm birth risk for Medicaid enrollees did not differ significantly from the privately insured.
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Affiliation(s)
- Emmanuel A Anum
- Department of Obstetrics & Gynecology and Institute on Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
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