TY - JOUR
T1 - Utilization of primary and obstetric care after medically complicated pregnancies
T2 - An analysis of medical claims data
AU - Bennett, Wendy L.
AU - Chang, Hsien Yen
AU - Levine, David M.
AU - Wang, Lin
AU - Neale, Donna
AU - Werner, Erika F.
AU - Clark, Jeanne M.
N1 - Funding Information:
Acknowledgements: Funding: Dr. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute, 5K23HL098476– 02.
PY - 2014/4
Y1 - 2014/4
N2 - BACKGROUND: Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended. OBJECTIVE: To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications. RESEARCH DESIGN: Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland. SUBJECTS: 7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy. MEASURES: We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type. RESULTS: Women with a complicated pregnancy were older at delivery (p<0.001), with higher rates of cesarean delivery (p<0.0001) and preterm labor or delivery (p<0.0001). Among women with Medicaid, 56.6 % in the complicated group and 51.7 % in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0 % in the complicated group and 49.5 % in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance. CONCLUSIONS: Women with pregnancy complications were more likely to attend primary care visits post-delivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.
AB - BACKGROUND: Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended. OBJECTIVE: To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications. RESEARCH DESIGN: Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland. SUBJECTS: 7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy. MEASURES: We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type. RESULTS: Women with a complicated pregnancy were older at delivery (p<0.001), with higher rates of cesarean delivery (p<0.0001) and preterm labor or delivery (p<0.0001). Among women with Medicaid, 56.6 % in the complicated group and 51.7 % in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0 % in the complicated group and 49.5 % in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance. CONCLUSIONS: Women with pregnancy complications were more likely to attend primary care visits post-delivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.
KW - gestational diabetes mellitus
KW - hypertension
KW - pregnancy
KW - primary care
KW - utilization of care
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U2 - 10.1007/s11606-013-2744-2
DO - 10.1007/s11606-013-2744-2
M3 - Article
C2 - 24474651
AN - SCOPUS:84898600343
SN - 0884-8734
VL - 29
SP - 636
EP - 645
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 4
ER -