Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits

Geissler, Kimberley H.; Ranchoff, Brittany L; Cooper, Michael I; Attanasio, Laura B.

doi:10.1001/jamanetworkopen.2020.25095

Cited by 24 publications

(23 citation statements)

References 65 publications

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“…In contrast to the low prevalence of services provided during comprehensive postpartum visits in a national sample, 42 the majority of patients in our community health center setting received all recommended components of postpartum care. The most prevalent postpartum services included family planning, follow-up regarding recovery from pregnancy and birth, and documentation of infant feeding status.…”

Section: Discussionmentioning

confidence: 66%

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Wouk

Kinlaw

Farahi

et al. 2022

Women's Health Reports

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Introduction: New clinical guidelines recommend comprehensive and timely postpartum services across 3 months after birth. Research is needed to characterize correlates of receiving guideline-concordant, quality postpartum care in federally qualified health centers serving marginalized populations. Methods: We abstracted electronic health record data from patients who received prenatal health care at three health centers in North Carolina to characterize quality postpartum care practices and to identify correlates of receiving quality care. We used multivariable log-binomial regression to estimate associations between patient, provider, and health center characteristics and two quality postpartum care outcomes: (1) timely care, defined as an initial assessment within the first 3 weeks and at least one additional visit within the first 3 months postpartum; and (2) comprehensive care, defined as receipt of services addressing family planning, infant feeding, chronic health, mood, and physical recovery across the first 3 months. Results: In a cohort of 253 patients, 60.5% received comprehensive postpartum care and 30.8% received timely care. Several prenatal factors (adequate care use, an engaged patient–provider relationship) and postpartum factors (early appointment scheduling, exclusive breastfeeding, and use of enabling services) were associated with timely postpartum care. The most important correlate of comprehensive services was having more than one postpartum visit during the first 3 months postpartum. Discussion: Identifying best practices for quality postpartum care in the health center setting can inform strategies to reduce health inequities. Future research should engage community stakeholders to define patient-centered measures of quality postpartum care and to identify community-centered ways of delivering this care.

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Section: Discussionmentioning

confidence: 66%

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Wouk

Kinlaw

Farahi

et al. 2022

Women's Health Reports

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“…Many medical specialties responded to the COVID‐19 pandemic by implementing telehealth services 12,29 . Given widespread patient dissatisfaction with the pre‐pandemic model of prenatal care and recent calls by the American College of Obstetric and Gynecology to make substantial changes in the postpartum care, it may not be surprising that there has been rapid adoption of telehealth in obstetric care during the pandemic 29‐35 . The evidence base for the effectiveness and safety of telehealth in obstetric and gynecologic care made it suitable for widespread dissemination and implementation 4 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of rapid telehealth implementation for prenatal and postpartum care visits during the COVID‐19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America

Reisinger‐Kindle

Qasba

Cayton

et al. 2021

Health Science Reports

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Background and aims COVID‐19 forced healthcare systems to implement telehealth programs, facilitated in Massachusetts by a policy requiring insurers to reimburse for telehealth visits. Prior studies suggest that telehealth is effective for obstetric care, but little is known about its implementation in response to policy changes in underserved communities. We utilized the RE‐AIM framework to evaluate telehealth implementation in a large academic urban obstetric practice that serves a medically underserved population. Methods RE‐AIM elements were assessed through retrospective review of electronic health record (EHR) data for all obstetric encounters between March 19 and August 31, 2020 and review of clinic implementation processes. Data extracted included demographics, number and type (in‐person or telehealth) of prenatal visits, prenatal diagnoses, delivery outcomes, and number and type of postpartum visits. Data were analyzed using descriptive statistics. Results A total of 558 patients (60.6% Hispanic; 13.2% primary language Spanish) had 1788 prenatal visits, of which 698 (39.0%) were telehealth visits. A total of 209 patients had 230 postpartum visits, of which 101 (48.3%) were telehealth visits. The Reach of the intervention increased from 0% of patients at baseline to 69% in August. Effectiveness measures were limited but suggested potential for earlier diagnosis of some prenatal conditions. Adoption was high, with all 30 providers using telehealth, and the telehealth was found to likely be feasible and acceptable based on uptake. Increases in the percentage of telehealth visits over time and continuation post‐lockdown suggested maintenance was potentially achievable. Conclusions The COVID‐19 pandemic has changed traditional approaches to healthcare delivery. We demonstrate that the use of the RE‐AIM framework can be effective in facilitating implementation of telephone visits in a large academic urban obstetric practice after state‐level policy change. This may be of particular importance in settings serving patients at higher risk for maternal morbidity and poor birth outcomes.

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“…All three topics examined in our study (contraception, depression and breastfeeding) were rated as very important and nearly always provided in a survey of clinicians who provide postpartum care [ 44 ]. Yet, a recent study examining documented postpartum visit content found that contraceptive counseling or provision occurred less than 50% of the time, while depression screening was documented in under 10% of visits, although provision of services did not vary by patient insurance status [ 27 ]. Our results suggest that experiences during the childbirth hospitalization may be another important factor predicting variation in postpartum visit content, and that further efforts to improve quality and equity in postpartum care are needed.…”

Section: Discussionmentioning

confidence: 99%

“…In prenatal care, for example, attending the recommended number of prenatal visits is insufficient for achieving good perinatal outcomes [20][21][22][23]; this finding has led to increasing interest in assessing the content and quality of prenatal care [24][25][26]. A recent study found that most recommended services were delivered at less than half of comprehensive postpartum visits, although there were few differences in provision of recommended services by whether or not the woman was insured by Medicaid [27]. Experiences of discrimination in healthcare generally or during pregnancy and childbirth specifically could affect the quality of care received in the postpartum visit by negatively impacting patient-clinician communication and adherence to recommendations and follow-up [28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content: Evidence from the Listening to Mothers in California survey

2021

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Objective Postpartum visits are an important opportunity to address ongoing maternal health. Experiences of discrimination in healthcare can impact healthcare use, including postpartum visits. However, it is unknown whether discrimination is associated with postpartum visit content. This study aimed to examine the relationship between perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content. Research design Data were from Listening to Mothers in California, a population-based survey of people with a singleton hospital birth in California in 2016. Adjusted logistic regression models estimated the association between perceived discrimination during the childbirth hospitalization and 1) postpartum visit attendance, and 2) topics addressed at the postpartum visit (birth control, depression and breastfeeding) for those who attended. Results 90.6% of women attended a postpartum visit, and 8.6% reported discrimination during the childbirth hospitalization. In adjusted models, any discrimination and insurance-based discrimination were associated with 7 and 10 percentage point (pp) lower predicted probabilities of attending a postpartum visit, respectively. There was a 7pp lower predicted probability of discussing birth control for women who had experienced discrimination (81% vs. 88%), a 15pp lower predicted probability of being asked about depression (64% vs. 79%), and a 9 pp lower predicted probability of being asked about breastfeeding (57% vs. 66%). Conclusions Amid heightened attention to the importance of postpartum care, there is a need to better understand determinants of postpartum care quality. Our findings highlight the potential consequences of healthcare discrimination in the perinatal period, including lower quality of postpartum care.

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Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits

Cited by 24 publications

References 65 publications

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Evaluation of rapid telehealth implementation for prenatal and postpartum care visits during the COVID‐19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America

Perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content: Evidence from the Listening to Mothers in California survey

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