Maternal and Child Health Research Program

Advancing Applied MCH Research

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(SDAS) Receipt of the Recommended Postpartum Visit and Effective Postpartum Contraception for Low-Income Illinois Women: A Medicaid Claims Analysis

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Project Number: R40MC26821
Grantee: University of Illinois
Department/Center: Division of Epidemiology and Biostatistics/ School of Public Health
Project Date: 04/01/2014

Final Report

Pending

Principal Investigator

Kristin Rankin, PhD
Assistant Professor
1603 W. Taylor St. (m/c 923)
Chicago, IL  60612
Phone: (312) 996-4870
Email: krankin@uic.edu

Abstract

The Affordable Care Act (ACA) has re-focused provider and researcher attention on the problem of how to coordinate medical care for childbearing women across the reproductive health continuum. Postpartum (PP) care, which has historically occurred at the 4-6 week PP visit, provides the critical link between pregnancy and well-woman healthcare through addressing chronic and acute health needs, assessing the emotional state of new mothers, delivering health promotion, and providing women with the tools needed to prevent an unplanned/unintended pregnancy. Specifically, improving women’s utilization of effective PP contraception has great potential to reduce unintended pregnancy and improve women’s and children’s health. However, among low-income Medicaid women in Illinois, fewer than sixty percent receive a PP visit. To develop adequate system and policy responses to ensure that low-income women receive the PP care they need, it is essential to document current patterns of PP care, including receipt of contraceptive services, and to examine factors associated with these patterns. Using Anderson’s model of health care utilization, we propose to address the following Specific Aims among IL Medicaid women who delivered a livebirth or stillbirth (fetal death) in 2009-2010: Aim A) To increase our understanding of the receipt, timing, and location of the recommended 4-6 week PP visit; Aim B) To increase our understanding of the receipt, timing, and location of the provision of effective contraception in the PP period; and, Aim C) To explore the relationship between receipt and timing of a PP visit and receipt and timing of effective PP contraception. For Aim C, two hypotheses will be tested: C.1) After controlling for predisposing, enabling and need factors, women who attend the PP visit are significantly more likely to obtain effective PP contraception within 6 weeks of delivery than their counterparts who do not attend the PP visit; and, C.2) After controlling for predisposing, enabling and need factors, among women who attend the PP visit, those who do so before or during the recommended window of 4-6 weeks post-delivery are significantly more likely to obtain an effective method of contraception earlier in the PP period than those with PP visits > 6 weeks post-delivery. Medicaid Analytic Extract (MAX) files for prenatal, delivery and early postpartum claims will be obtained for IL Medicaid women delivering between September 1, 2009 and August 31, 2010. Independent (predisposing, enabling and need) and dependent (receipt and timing of PP visit; receipt and timing of effective PP contraception) variables will be created from MAX data and analytic approaches will include multivariable log binomial and Cox proportional hazards regression models; use of the latter will enable an in-depth look at the timing of PP contraception. By using claims data, this study will tap into a wealth of information about the timing and provider/location of the PP visit as well as the timing, provider/location and type of contraception obtained in the early PP period. Overall, examining the receipt of PP contraception in relation to the PP visit will provide key information to improve the effectiveness and timing of PP care. As such, this study is directly relevant to MCHB’s Strategic Research Issue # III. Services and Systems to Assure Quality of Care for MCH Populations: study findings can inform the development of interventions to increase access to and use of health care during a critically important but traditionally ignored period in a woman’s life course

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