Predictors of postpartum follow-up among North Carolina Medicaid recipients

Background

Postpartum visits are a vital part of maternity care, presenting the opportunity to perform well woman care, address contraceptive needs, and screen for postpartum depression and chronic disease. North Carolina’s Pregnancy Medical Home (PMH) program for Medicaid patients offers maternity providers an incentive payment for postpartum visits completed within 60 days of delivery.  This analysis identifies variables associated with completed postpartum visits in North Carolina, allowing us to target interventions to improve postpartum visit attendance.

Methods

Medicaid claims and birth certificate data for 28,394 pregnancies occurring between April 1st and December 31st 2012 to Medicaid patients who received prenatal care from a PMH were analyzed for predictors of postpartum follow-up using SAS 9.2. Postpartum visit attendance was identified using a unique billing code that PMHs used for receiving the incentive. 12,855 women had a paid postpartum follow-up claim.  We used chi square and logistic regression analyses to identify variables associated with postpartum visit attendance.

Results

Women with a poor birth outcome, late entry to prenatal care, multiparity, black or Hispanic race/ethnicity, and advanced maternal age were all significantly less likely to have attended a postpartum follow-up. Women who received care management, were enrolled in Medicaid for Pregnant Women or had one or more identified risk factors for preterm birth were significantly more likely to have completed a postpartum visit.

Conclusions

Identified predictors of postpartum follow-up suggest opportunities to improve adherence to postpartum visits. Care management is one possible intervention to improve attendance and should undergo further study.