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Abstract #149789
Audio (mp3) recordingLee Anne Roman, MSN, PhD1, H. Lynette Biery, PA-C2, Wm. Thomas Summerfelt, PhD3, Shelby Berkowitz Chartkoff, MA4, Jennifer E. Raffo, MA5, Cristian I. Meghea, PhD2, Susan M. Moran, BSN, MPH6, and Denise Holmes, MS2. (1) Department of Ob/Gyn and Institute for Health Care Studies, Michigan State University, A126 East Fee Hall, Michigan State University, East Lansing, MI 48824, 517-432-3990, lroman@msu.edu, (2) Institute for Health Care Studies, Michigan State University, A126 East Fee Hall, East Lansing, MI 48824, (3) Center for Health and the Social Sciences/Department of Medicine, The University of Chicago, 5841 S. Maryland Avenue, MC 1000, G-115B, AMB, Chicago, IL 60637, (4) Community Research Institute, Johnson Center for Philanthropy, Grand Valley State University, 401 West Fulton, 288C, Grand Rapids, MI 49504, (5) Research Division, Grand Rapids Medical Education & Research Center, 1000 Monroe Avenue, NW, Grand Rapids, MI 49503, (6) Bureau of Medicaid Program Operations & Quality Assurance, Michigan Department of Community Health, P. O. Box 30479, 400 S. Pine Street, Lansing, MI 48909
Background: Medicaid insures almost 40% of births in the U.S. and, with federal MCH block grant funding, provides additional resources for enhanced prenatal services (EPS) to improve pregnancy outcomes. Despite these investments, health disparities persist at birth. We report on Michigan's efforts to evaluate and redesign an EPS program and the development and feasibility testing of a two tiered risk screening and assessment tool.
Methods: We describe a state-wide evaluation of EPS program participation by maternal risks (N = 46,617). We also describe preliminary results using the new tool, which includes well established instruments for stress, health behaviors and mental health, in a convenience sample of Medicaid insured women (N = 816).
Findings: Many women with modifiable risk factors were not receiving EPS services (e.g. statewide 72% of women who reported smoking had no program contact). The new tool revealed important nuances in maternal risks. For example, 32% of women reported smoking. Of them, 16% smoke a pack/day or more, 50% are highly addicted, and 54% have tried to quit. Also, while 54% of women screened positive using a brief depression screen (PHQ-2), a second tier assessment (Edinburgh Depression Scale), indicated that 34% of these women had symptoms consistent with probable major depression. Additional results will be presented.
Policy Implications: The new tool reveals important information to tailor evidence-based strategies to level of risk and readiness to change. Changes in state Medicaid policy (e.g. reimbursement) were made to support implementation. Implications for program change will be discussed.
Learning Objectives:
- Describe the relationship between maternal risk characteristics and participation in a state-sponsored, Medicaid enhanced prenatal services program.
- Recall benefits of a two-tiered risk screening and assessment tool designed to guide the tailoring of services to risk level.
- Identify Medicaid program policy implications using the risk screening and assessment tool.
Keywords: Medicaid, Screening Instruments
Presenting author's disclosure statement:
Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA