Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina
Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina
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DOI：
10.1007/s10995-016-1935-y
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发表时间：
2016-07-01
影响因子：
2.3
通讯作者：
Covington-Kolb, Sarah
中科院分区：
文献类型：
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作者：
Gareau, Sarah;Lopez-De Fede, Ana;Covington-Kolb, Sarah
目的本研究旨在确定在南卡罗来纳州的一个试点项目中，参加CenteringPregnancy组产前护理计划的医疗补助妇女预防不良出生结局的成本节约。方法回顾性五年队列研究的医疗补助妇女进行了评估的差异，在参与CenteringPregnancy组产前护理（n = 1262）和那些接受个人产前护理（n = 5066）的妇女的出生结局。研究结果检查早产和低出生体重（LBW）和新生儿重症监护室（NICU）访问的相关结果。由于女性未被分配到CenteringPregnancy组，倾向评分分析确保了治疗组之间出生结局估计差异的推断根据年龄、种族、临床风险组和计划类型的非随机分配进行了调整。运行一系列广义线性模型来估计CenteringPregnancy组产前护理参与中不良出生结局个体比例之间的差异或风险差异。然后使用估计的风险差异（来自身份链接二项式方差广义线性模型的CenteringPregnancy组指标变量的系数）计算因参加CenteringPregnancy组而节省的潜在成本。结果本研究估计，CenteringPregnancy参与降低早产风险（36%，P < 0.05）。每预防一次早产，平均可节省22 667美元的保健开支。参加CenteringPregnancy降低了分娩低出生体重儿的发生率（44%，P < 0.05，$29，627）。此外，CenteringPregnancy参与者的婴儿入住NICU的风险降低（28%，P < 0.05，27，249美元）。在考虑到170万美元的国家投资后，估计投资回报率接近230万美元。结论：由于低风险医疗补助受益人参与CenteringPregnancy，节省了成本，取得了更好的结果。
Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.