Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Bennett, Wendy L.; Chang, Hsien Yen; Levine, David M.; Wang, Lin; Neale, Donna M; Werner, Erika F.; Clark, Jeanne M.

doi:10.1007/s11606-013-2744-2

Cited by 151 publications

(115 citation statements)

References 33 publications

(34 reference statements)

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“…20,[22][23] Yet even women with pregnancy complications often miss their postpartum visits. 22,[24][25][26][27][28] Low-income women-who have disproportionate prevalence of gestational diabetes and hypertensive disorders in pregnancy 4,[29][30] -have multiple barriers to outpatient follow-up in the postpartum period. 31 These barriers include lack of childcare, schedule demands, difficulty accessing care, and lack of understanding about the long-term health risks associated with pregnancy complications 31 and may increase women's reliance on emergency room (ER) settings.…”

Section: In 2008 Inmentioning

confidence: 99%

“…To describe socioeconomic variables not available in our claims data we used zip code at the time of delivery to link with zip codelevel neighborhood characteristics in the 2000 U.S. Census Bureau's American Community Survey using methods from the Dartmouth Atlas of Healthcare. 24,44 This data set met the definition of a limited data set under the Health Insurance Portability and Accountability Act, and was approved by the Johns Hopkins University School of Medicine Institutional Review Board.…”

Section: Study Design and Data Set Descriptionmentioning

confidence: 99%

“…We identified pregnancies and deliveries using an International Classification of Diseases, ninth revision (ICD-9) and current procedural terminology code-based definition from the National Center for Quality Assurance's Healthcare Effectiveness Data and Information Set measures and additionally added codes for stillborn and multiple gestation births. 24,45,46 We required at least one insurance claim in the 2 weeks prior and subsequent to the delivery date to ensure an accurate delivery date.…”

Section: Sample Selectionmentioning

confidence: 99%

See 2 more Smart Citations

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Harris

Chang

Wang

et al. 2015

Journal of Women's Health

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Background: Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and preeclampsia) have increased ER use in the first 6 months postpartum, compared with women without these complications. Methods: We conducted a retrospective population-based cohort study using a 2003-2010 Maryland Medicaid managed care claims data set, linked with U.S. Census data. Data included claims for outpatient and ER visits for women aged 12-45 years who were continuously enrolled in Medicaid for at least 100 days of pregnancy and 90 days postpartum. We used logistic regression to calculate the association between pregnancy complications and having ‡1 ER visit in the 6 months postpartum. Results: We identified 26,074 pregnancies, of which 20% were complicated by GDM, gestational hypertension, or preeclampsia. Of these complicated pregnancies, 42.1% had GDM, 35.4% had gestational hypertension, and 42.5% had preeclampsia (diagnoses were not mutually exclusive). In the 6 months postpartum, 25% of women had ‡1 ER visits. Of the complicated pregnancy group, 27.7% had ‡1 ER visit, versus 23.6% of the comparison group ( p < 0.0001). In adjusted analyses, women with a pregnancy complication were more likely to have ‡1 ER visit compared with women without these complications (odds ratio [OR]1.14, 95% confidence interval [CI] 1.05-1.23). The strength of association was highest in women under age 25 (OR 1.20, 95% CI 1.09-1.33). Preconception medical comorbidities (type 2 diabetes, chronic hypertension, obesity, asthma, mental health, and substance abuse diagnoses) were also strongly associated with postpartum ER use (OR 1.61, 95% CI 1.51-1.73). Conclusions: Pregnancy complications increased ER utilization during the 6 months postpartum, especially among women under age 25 years. Interventions that improve discharge planning and early postpartum care may decrease ER use.

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Section: In 2008 Inmentioning

confidence: 99%

Section: Study Design and Data Set Descriptionmentioning

confidence: 99%

Section: Sample Selectionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Harris

Chang

Wang

et al. 2015

Journal of Women's Health

Self Cite

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“…As pregnancy is more likely to be complicated for women with diabetes, and hyperglycemia increases risk of adverse birth outcomes [8], focused efforts on interconception care for women with diabetes are warranted. This is particularly true in California, where rates of preconception diabetes are higher than have been previously reported for Medicaid populations [16].…”

Section: Discussionmentioning

confidence: 73%

Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program

et al. 2017

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Objectives: To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus. Methods: A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception. Results: Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=b.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33). Conclusions: Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies. Implications: Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following pregnancies complicated by diabetes.

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“…However, recent studies indicate that many women do not attend obstetric or medical visits after birth. Even for mothers with medically complex pregnancies, only half to two-thirds attend obstetric visits within 3 mo of delivery or make a primary care visit within 1 y of delivery (27). Therefore, bridging the efficacy to effectiveness gap for mothers of young children is likely to require interventions in pediatric settings.…”

mentioning

confidence: 99%

Beyond screening: a review of pediatric primary care models to address maternal depression

et al. 2015

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Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.D epression is one of the most debilitating chronic disorders in the United States (1), a fact experienced every day by the 15 million children being raised in homes with depressed mothers (2). Children living with depressed mothers may experience household chaos, inconsistent nurturing, inadequate safety practices, harsh discipline, and child maltreatment (3,4). Compared to nonexposed peers, children of depressed mothers are two to three times more likely to develop psychiatric disorders themselves and to do poorly in school (5-9). Moreover, recent studies suggest that remission of maternal depression is associated with significant improvement in child behavioral and mental health outcomes (10). Children's home, family, and social environments appear to explain the majority of the risk for the intergenerational transmission of depression (11), with genetics contributing less than half of the risk (10,12). It is the immediate family environment, what Bronfenbrenner refers to as "proximal processes, " that powerfully shapes children's neural, cognitive, social, and behavioral development (13). Thus, it is imperative to promote the safety and wellbeing of children living in homes with depressed mothers.According to the 2009 US National Academies of Science review of maternal depression, "Few opportunities exist to identify the vulnerable population of children living in households with one or more parents experiencing depression or to offer prevention and treatment services that can improve the care of the depressed parent in a framework that also offers services for children" (2). The pedi...

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Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Cited by 151 publications

References 33 publications

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program

Beyond screening: a review of pediatric primary care models to address maternal depression

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