Healthcare Patterns of Pregnant Women and Children Affected by OUD in 9 State Medicaid Populations.
Healthcare Patterns of Pregnant Women and Children Affected by OUD in 9 State Medicaid Populations.
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DOI：
10.1097/adm.0000000000000780
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发表时间：
2021-09-01
影响因子：
5.5
通讯作者：
Donohue JM
中科院分区：
文献类型：
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作者：
Jarlenski M;Kim JY;Ahrens KA;Allen L;Austin A;Barnes AJ;Crane D;Lanier P;Mauk R;Mohamoud S;Pauly N;Talbert J;Zivin K;Donohue JM
州医疗补助计划是为患有阿片类药物使用障碍 (OUD) 的孕妇提供最大的单一医疗保健服务提供者。我们的目标是提供可比较的多州衡量指标，估计妊娠期 OUD 负担、妊娠期阿片类药物使用障碍 (MOUD) 药物以及相关新生儿和儿童结局。利用医疗补助结果分布式研究网络 (MODRN)，我们获取了 2014 年至 2017 年 9 个州医疗补助人口中 160 万次怀孕和 130 万例活产的行政医疗数据。我们分析了以下结果的州内和州间患病率和时间趋势：妊娠期 OUD 的诊断、妊娠期 MOUD 的启动和持续性、新生儿阿片类药物戒断综合征 (NOWS) 以及 NOWS 儿童的健康儿童就诊利用率。在我们的研究期间，OUD 诊断从每 1,000 名妊娠 49.6 例增加到每 1,000 名妊娠 54.1 例，妊娠期患有任何 MOUD 的比例从 53.4% 增加到 57.9%。 MOUD 180 天连续性的州特定百分比范围为 41.2% 至 84.5%。诊断患有NOWS 的新生儿比率从每 1,000 名活产儿 32.7 人增加到 37.0 人。在被诊断患有NOWS 的儿童中，在前 15 个月内接受建议的儿童健康检查的州特定百分比范围为 39.3% 至 62.5%。医疗补助数据允许对不同环境下的护理进行纵向监测，可用于监测 OUD 以及相关的妊娠和儿童健康结果。研究结果强调，需要采取公共卫生措施来改善对受 OUD 影响的孕妇和儿童的护理。
State Medicaid programs are the largest single provider of healthcare for pregnant persons with opioid use disorder (OUD). Our objective was to provide comparable, multi-state measures estimating the burden of OUD in pregnancy, medication for opioid use disorder (MOUD) in pregnancy, and related neonatal and child outcomes. Drawing on the Medicaid Outcomes Distributed Research Network (MODRN), we accessed administrative healthcare data for 1.6 million pregnancies and 1.3 million live births in 9 state Medicaid populations from 2014–2017. We analyzed within- and between-state prevalences and time trends in the following outcomes: diagnosis of OUD in pregnancy, initiation and continuity of MOUD in pregnancy, Neonatal Opioid Withdrawal Syndrome (NOWS), and well-child visit utilization among children with NOWS. OUD diagnosis increased from 49.6 per 1,000 to 54.1 per 1,000 pregnancies, and the percentage of those with any MOUD in pregnancy increased from 53.4% to 57.9%, during our study time period. State-specific percentages of 180-day continuity of MOUD ranged from 41.2% to 84.5%. The rate of neonates diagnosed with NOWS increased from 32.7 to 37.0 per 1,000 live births. State-specific percentages of children diagnosed with NOWS who had the recommended well-child visits in the first 15 months ranged from 39.3% to 62.5%. Medicaid data, which allow for longitudinal surveillance of care across different settings, can be used to monitor OUD and related pregnancy and child health outcomes. Findings highlight the need for public health efforts to improve care for pregnant persons and children affected by OUD.