Background: Although severe maternal morbidity (SMM) is associated with adverse health outcomes in the year after delivery, patterns of health care use beyond the 6-week postpartum period have not been well documented.

Objective: To estimate health care utilization and expenditures for deliveries with and without SMM in the 12 months following delivery among commercially insured patients.

Methods: Using data from the 2016-2018 IBM Marketscan Commercial Claims and Encounters Research Databases, we identified deliveries to individuals 15-49 years of age who were continuously enrolled 12 months after delivery discharge. We used multivariable generalized linear models to estimate adjusted mean 12-month expenditures and 95% confidence intervals (CI) for deliveries with and without SMM, accounting for region, health plan type, delivery method, and obstetric comorbidities. We estimated costs associated with inpatient admissions, outpatient visits, emergency department visits, and outpatient pharmaceutical claims.

Results: We identified 366,282 deliveries without SMM and 3,976 deliveries (1.1%) with SMM. Adjusted mean total expenditures for deliveries with SMM were 44% higher in the 12 months after discharge than deliveries without SMM ($5,484 vs $3,041; difference $2,443, 95% CI: $2441-2445). Adjusted mean expenditures for readmissions and outpatient visits during the 12-month postpartum period were 65% and 39% higher, respectively, for deliveries with SMM and without SMM. Among deliveries with SMM, adjusted mean total costs were highest for patients having a repeat cesarean ($7227, 95% CI $7183-7271).

Conclusions: SMM at delivery is associated with increased health care expenditures in the year after delivery. These estimates can inform planning of SMM prevention efforts.

Pediatric readmissions have negative consequences for families and add health care costs however the pediatric inpatient population has received limited attention. This study sought to measure pediatric unplanned readmissions, calculate readmission rates at acute care hospitals in Massachusetts, and analyze differences by patient and discharge characteristics at the population level.

This analysis adapted the Pediatric All-Condition Readmission Measure developed by the Center of Excellence for Pediatric Quality Measurement to classify admissions resulting in readmission with 30 days of discharge. Pediatric (up to age 18 years plus 30 days) inpatient hospitalizations at acute care hospitals in Massachusetts with an index admission between July 1, 2017 and June 30, 2021 sourced from the Massachusetts Acute Hospital Case Mix Database.

The all-payer pediatric readmission rate in Massachusetts in 2021 was 4.6% and remained stable across study years amidst annual declines in eligible index discharges. Readmission rates were higher for patients aged 1-4 (6.9%) and 5-7 years (6.2%) compared to patients under age 1 (3.4%; p<0.001), and visits with Medicaid (4.7%) as the expected primary payer type compared to visits with commercial payers (4.2%; p<0.05). Readmission rates were higher for medically complex chronic patients (10.4%) compared to non-complex chronic (3.7%) and non-chronic patients (2.3%; p<0.001).

Better understanding patterns of acute care hospital use for pediatric patients is an important step in improving pediatric outcomes, reducing healthcare costs, and addressing disparities. This inaugural statewide study found that one in twenty Massachusetts pediatric patients had a readmission, with higher rates seen in patients insured by Medicaid.

Insurers are increasingly incentivizing social risk factors (SRF) screening within healthcare settings; it is unknown how clinics are subsequently implementing this screening.

In 2022, a major insurance provider in Kansas City incentivized validated SRF screening with at least 4 required domains (food, housing, transportation, and social environment). We surveyed 25 integrated pediatric practices affiliated with a children’s hospital, inquiring about which screening instrument was utilized, screening administration, barriers to screening, and response to positive screens. Practices could select multiple answers per question. Simple descriptive statistics were used.

All practices completed the survey. Practices administered the survey on paper (56%), electronic (48%), verbally (12%) and via signage (4%). Screening was self-administered (40%) or administered by nurses (36%), front desk staff (16%), medical assistants (12%), or providers (4%). In response to positive screens, practices provided one or more of the following: the link to FindHelp, an electronic portal with information on community resources by need and zip-code (72%); electronic referrals to community organizations through FindHelp (72%); printed resources from FindHelp (28%); verbal information on resources (44%); premade resource sheets (20%); phone calls to community organizations (8%); referrals to resource(s) within the practice (12%); or coordinated care via a social worker/care coordinator (16%). 16 practices endorsed barriers to screening—most common was parental reluctance or embarrassment (40%).

Implementation variation exists in response to a financial incentive to adopt SRF screening, even within an integrated practice network. Further research into the efficacy of these different methods is warranted, along with interventions to mitigate any barriers.

Background The COVID-19 pandemic has significantly affected maternal health services especially for racial/ethnic minority women, bringing big challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study investigates the social and structural determinants of maternal care service utilization and quality of care that affected African American and Hispanic pregnant and postpartum women during the COVID-19 pandemic in South Carolina (SC).

Methods We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from obstetric and pediatric clinics in SC in 2021. Interview transcripts were analyzed thematically.

Results Maternal care service utilization and provision was influenced by factors at different levels, including intrapersonal, interpersonal, institutional, community, and policy level. Barriers included 1) personal beliefs and fears related to COVID-19 risk (intrapersonal); 2) lack of interactions with social networks and support systems (interpersonal); 3) hospitals not allowing family members to accompany visits, MCPs practices limited by COVID-19 control policies, and even being asked to discharge early after giving birth (institutional); and 4) inability to navigate complex policy changes (policy barrier). The timely fill-in of community health workers and doulas was identified as a community level facilitator.

Conclusion The pandemic has exacerbated existing disparities in maternal health care service utilization and provision. To improve maternal health outcomes, it is crucial to provide adequate resources and support for MCPs and strengthen community partnerships to ensure equitable access to care.

Background: The World Health Organization defines a maternal near miss (MNM) as, “a very ill pregnant or delivered birthing person who nearly died but survived a complication during pregnancy, childbirth, or postpartum up to 42 days.” There is limited information on the lived experiences of those with MNM. The objective of this study was to codify birthing people of color’s lived experiences of severe maternal morbidity (SMM) and MNM and communicate them as data points that influence health care strategies, clinical practice, and policy.

Methods: Between July 2021 and April 2022, 87 virtual interviews were conducted among birthing people, who self-identified as a person of color, about their experiences of MNM and/or SMM. The interviews were designed to explore these stories using narrative-based medicine. The Three Delays Model, Intersectionality, and the ICHOM Set of Patient-Centered Outcome Measures for Pregnancy and Childbirth informed the interview guide.

Results: Seventy-five percent of participants self-identified as Black/African American, 95.7% of participants were 25-44 years, and 83.7% of participants completed college or a graduate/professional degree. 46.2% of participants suffered from severe preeclampsia, and 26.4% experienced severe postpartum hemorrhage. The majority of participants shared their experiences of discrimination and racism, themes centered around stereotypes, experiencing a lack of compassion and empathy from healthcare providers, and an overall dismissal of pain.

Conclusions: Structural racism played a major role how birthing people were treated by health care providers and the healthcare system. Recommendations include equitable care training for providers, the promotion of workforce diversification, and health system disparity dashboards.

Background: Family physicians play a key role in access to maternity care by providing delivery services in rural areas and under-served communities. Their role in ensuring access is particularly important in the context of rising rates of maternal mortality and severe maternal morbidity in the United States, as well as the stark racial disparities in birth outcomes. However, recent research suggests that the percentage of family physicians choosing to provide maternity care, particularly delivery care, has decreased, contributing to provider scarcity in some settings.

Objective: This study aims to explore family medicine residents' concepts of obstetric care and to identify training factors that influence their decision to offer obstetric care/delivery services.

Methods: Concept Mapping was used for on-line data collection and initial participatory analysis, to explore how family medicine residents conceptualize obstetric care in general and obstetric training in particular, in relation to their decision to provide—or not to provide—maternity services in their future practice.

Results: Eighteen residents participated in the Brainstorming phase, generating 80 unique items; 17 participated in the Sorting & Rating phase; and 44 attended in-person sessions to discuss and interpret the concept point maps and clusters. Training environment, approach and confidence-building emerged as key decision-making factors. Point maps, clusters, and a “go-zone” matrix for modifiable training components will be presented.

Conclusions: This small mixed-methods study provides insight into family medicine residents’ decision-making around maternity care provision. Findings point to needs for well-supported training that allows residents to feel competent, supported and included in the obstetric team.

Background:

Continuous and adequate health insurance coverage is critical to access preventive care services and improving health outcomes. In contrast, lack of health insurance coverage or underinsurance often predisposes increased reliance on emergency departments for regular care as substitutes for primary care. The objective of this study is to examine the association between health insurance status and emergency room and preventive care utilization among children in the US.

Methods:

We conducted a pooled, cross-sectional, secondary data analysis, using data from the 2016-2021 National Survey of Children's Health (NSCH). Survey-weighted multivariable logistic regression analyses were to estimate variations in emergency department visits and preventive care services utilization by varying types of health insurance, controlling for children’s sociodemographic and household-level factors.

Preliminary Results:

Preliminary analysis showed that of 49.46 million children, 87% had continuous, adequate health insurance coverage and a regular provider, while 4.67% were uninsured with no adequate coverage or usual source, and 4.89% were underinsured. Uninsured and underinsured children had lower odds of using preventive care (uninsured: AOR=0.373, p=0.000), but higher odds of emergency department visits (uninsured: AOR=1.006, p=0.000; underinsured: AOR=1.805, p=0.000) than fully insured children.

Conclusion:

This study emphasizes the importance of comprehensive health insurance coverage to receive preventive healthcare services, in the absence of which costly emergency departments are used as substitutes. Our results highlight the need for policies and interventions to bolster comprehensive coverage and access to care among US children.

Background: Pregnancy alone leads to more use of healthcare services and when pregnant women have disabilities like spinal cord injury (SCI) or paralysis, the healthcare utilization can be even more. The purpose of this research study was to evaluate the impact of SCI/paralysis on the inpatient department healthcare utilization of pregnant women compared to the inpatient department healthcare utilization of pregnant women without SCI/paralysis in the United States.

Methods: We used the National Inpatient Sample from 2006 through 2019. Outcome variables were length of hospital stay and total hospitalization charges. Independent variables included patient demographics, socioeconomic status, and hospital characteristics. We employed propensity-score kernel matching to determine the impact of SCI/paralysis on the healthcare services utilization for inpatient hospitalization encounters of pregnant women.

Results: The total inpatient encounters of pregnant women with SCI/paralysis and without SCI/paralysis were 3,174 and 7,732,029, respectively. The average length of hospital stay among pregnant women with SCI/paralysis was 7.74 days (+/- 14.88) whereas for those without SCI/paralysis was 2.87 days (+/- 3.01). The average treatment effect suggested that the pregnant women with SCI/paralysis have on average, a length of stay about three days longer and a total hospitalization charge approximately $30,393.23 more than those without SCI/paralysis.

Conclusions: The results can be used as a starting point by healthcare providers to stratify the risks for pregnant women with SCI/paralysis based on their demographic and socioeconomic characteristics to make informed decisions regarding the need for healthcare policies for this population.

Background: Pregnant people and their newborns are at greater risk of severe vaccine-preventable diseases. Currently, three vaccines are recommended during pregnancy: influenza, COVID-19, and Tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Although disparities between publicly and privately insured pregnant people have been previously documented for influenza vaccines, limited data have evaluated potential disparities in the uptake of other recommended vaccines, including COVID-19.

Methods: Using a previously validated algorithm to identify pregnancy outcomes, we constructed a claims-based cohort of privately insured pregnancies from the Merative® Marketscan® Commercial Database and publicly insured pregnancies from the Merative® Marketscan® Multi-state Medicaid Database. We included all pregnancies with an estimated date of conception from 11 December 2020 (i.e., COVID-19 vaccine authorization). We used outpatient and inpatient services and outpatient drug records to identify influenza, COVID-19, and Tdap vaccination during pregnancy.

Results: Between 11 December 2020 and 31 December 2021, we identified 187,603 publicly insured pregnancies and 169,006 privately insured pregnancies. On average, uptake of influenza, COVID-19, and Tdap vaccines was 16% lower among publicly insured compared to privately insured pregnancies (influenza: 15.5% vs. 24.0%; ≥1 dose of COVID-19: 11.2% vs. 28.9%; Tdap: 31.7% vs. 53.8%, respectively). To consider possible delays in vaccine access by insurance type, future planned analyses will compare time to vaccination among publicly and privately insured pregnancies.

Conclusions: Despite the health benefits, uptake of recommended vaccines among pregnant people is suboptimal - particularly for pregnant people utilizing Medicaid. Vaccine promotion efforts are needed to increase the percent of pregnancies protected by immunization, especially for Medicaid enrollees.