Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
复制标题
DOI：
10.1007/s11606-013-2744-2
复制
发表时间：
2014-04-01
影响因子：
5.7
通讯作者：
Clark, Jeanne M.
中科院分区：
文献类型：
--
作者：
Bennett, Wendy L.;Chang, Hsien-Yen;Clark, Jeanne M.
由于妊娠并发症，包括妊娠期糖尿病（GDM）和妊娠期高血压疾病，是糖尿病和心血管疾病的危险因素，建议产后随访。确定有或无医学并发症妇女产后初级和产科护理利用的预测因素。在马里兰州使用商业和医疗补助保险索赔的5年回顾性队列研究中，7741名合并妊娠（GDM、高血压疾病和妊娠期糖尿病[DM]）的妇女和23599名合并妊娠的妇女。我们比较了复杂妊娠组和对照妊娠组分娩后12个月内初级和产后产科护理的使用率。我们进行了多变量逻辑回归来评估妊娠并发症、社会人口学预测变量和护理利用之间的关系，并按保险类型分层。复杂妊娠的妇女分娩时年龄较大（p < 0.001），剖宫产（p < 0.0001）和早产或分娩（p < 0.0001）的发生率较高。在接受医疗补助的妇女中，56.6%的复杂组和51.7%的对照组参加了初级保健就诊。接受初级保健访问的统计显著预测因素包括非黑人种族、年龄较大、先兆子痫或糖尿病和抑郁症。在有商业健康保险的妇女中，60.0%的复杂组和49.5%的对照组参加了初级保健就诊。妊娠并发症不能预测有商业保险妇女的初级保健就诊。与对照组相比，有妊娠并发症的妇女分娩后更有可能接受初级保健就诊，但总体就诊率较低。虽然扩大医疗补助有可能扩大覆盖面，但需要创新的产后预防保健服务模式，以慢性病发展风险较高的妇女为目标。
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.To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications.Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland.7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy.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.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.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.