Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care.
Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care.
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医疗补助托管护理中避孕和怀孕意图的文件。
DOI：
10.1177/2333392817748870
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发表时间：
2018-01
影响因子：
1.6
通讯作者：
Hulett D
中科院分区：
文献类型：
--
作者：
Thiel de Bocanegra H;McKean A;Darney P;Saleeby E;Hulett D
临床指南建议在初级保健访问期间记录怀孕意图和计划生育需求。在2014年医疗补助扩展和发布这些指南之前，医疗补助管理式医疗服务提供者的记录做法是未知的。我们对1054名13至49岁女性的医疗补助管理护理访问进行了图表审查，以探索与立即或未来计划生育和避孕方法使用相关的客户，提供者和访问特征。五个管理式护理计划使用了现行程序术语和国际疾病分类第九次修订版代码，以确定2013年至少有15名妇女接受过计划生育或妇女保健的提供者。我们以避孕方法和怀孕意愿作为结局变量，以诊所作为2级随机效应进行多水平logistic回归分析。只有12%的图表记录了怀孕意图，59%记录了避孕措施的使用。与有计划生育访视原因的女性相比，有年度、生殖健康或初级保健访视原因的女性记录避孕的可能性显著降低（比值比[OR] = 11.0; 95%置信区间[CI] = 6.8-17.7）。年龄也是一个重要的预测因素，30至49岁的女性（OR = 0.6; 95% CI = 0.4-0.9），13至19岁的女性（OR = 0.2; 95% CI = 0.1-0.6）不太可能在图表中注明怀孕意图。在多专科诊所更可能记录到妊娠意向（OR = 15.5; 95%CI = 2.7-89.2）。无论患者年龄和就诊特征如何，都需要采取干预措施，改善避孕和怀孕意愿的常规病历记录，以促进在管理式护理就诊中提供计划生育，并最终实现更好的母婴健康结果和降低成本。
Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7). Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9), and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6) being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2). Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes and reduced costs.
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DOI：
10.1136/amiajnl-2014-002726
发表时间：
2015-01
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Burke HB;Sessums LL;Hoang A;Becher DA;Fontelo P;Liu F;Stephens M;Pangaro LN;O'Malley PG;Baxi NS;Bunt CW;Capaldi VF 2nd;Chen JM;Cooper BA;Djuric DA;Hodge JA;Kane S;Magee C;Makary ZR;Mallory RM;Miller T;Saperstein A;Servey J;Gimbel RW
通讯作者：
Gimbel RW
影响因子：
5.5
作者：
Tsui, Amy O.;McDonald-Mosley, Raegan;Burke, Anne E.
通讯作者：
Burke, Anne E.
影响因子：
12.7
作者：
Fridman, Moshe;Korst, Lisa M.;Gregory, Kimberly D.
通讯作者：
Gregory, Kimberly D.
影响因子：
158.5
作者：
Finer, Lawrence B.;Zolna, Mia R.
通讯作者：
Zolna, Mia R.
DOI：
10.1111/1468-0009.12080
发表时间：
2014-12
期刊：
The Milbank quarterly
影响因子：
--
作者：
Frost JJ;Sonfield A;Zolna MR;Finer LB
通讯作者：
Finer LB