Affordable Care Act: Improving Health Service Utilization in Childbearing Women
Methods: A cohort analysis of Medicaid-insured mother-infant pairs in Kent County, Michigan (singleton births, 2009, N=4,484) was conducted using linked vital records and claims data from the Michigan Department of Community Health Warehouse (*p=<0.01).
Results: Half of all pregnant women had pre-pregnancy Medicaid. Compared to women without prior Medicaid, 24% of women with pre-existing Medicaid (vs. 25%) had inadequate/intermediate prenatal care; 65% (vs.67%) initiated first trimester care; 41% (vs.25%*) enrolled in EPC; and 21% (vs.5%*) had 3 or more prenatal emergency department (ED) visits. While 56% (vs.43%*) completed a postpartum visit, 15% (vs.7 %*) used the ED during 8 weeks post-birth. In the postpartum year, of those who had Medicaid before/after birth, 22% (vs.8 %*) had 3 or more ED visits.
Conclusions: Women with prior Medicaid were more likely to engage in EPC and postpartum visits, but there was still low participation; one in five women had frequent prenatal or postnatal ED use. EPC programs, in 66% of states, could be optimized with targeted interventions to help newly-insured women use health resources. Community improvement strategies and early implementation findings will be discussed.
Learning Areas:Public health or related research
Describe health service utilization in childbearing women; discuss community implementation strategies initiated for service utilization improvement
Qualified on the content I am responsible for because: I am health services researcher/masterâs-prepared nurse. I have led a team of researchers to inform improvements and conduct a rigorous evaluation of the Michigan enhanced prenatal services (EPC) program and am conducting a similar evaluation of a federal Healthy Start program. I lead an AHRQ five year research and demonstration project to develop a population perinatal system of care and, based on the submitted study, will discuss early implementation strategies and preliminary service utilization improvements.
Any relevant financial relationships? No
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.