Abstract
Purpose
To examine factors affecting prenatal and postpartum care for an insured, but vulnerable,
population.
Methods
Individual-level data on three measures of care adequacy were obtained for Massachusetts
Medicaid Managed Care women who met the National Committee on Quality Assurance’s
Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal
and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial
logistic function with individual and neighborhood characteristics, provider type,
and health plan as explanatory variables.
Findings
In our sample, 85% of women initiated care in the first trimester, but only 62% met
the goal of receiving more than 80% of the recommended number of prenatal visits.
Just 60% had a timely postpartum care visit. Having a diagnosis of substance abuse
or dependence reduced the odds of meeting all measures. Women with disabilities were
less likely to attain two of the three measures of adequate care, as were women with
other children in the household. Women who enrolled in Medicaid in the first trimester
were more likely to receive the recommended number of prenatal visits than those who
were enrolled before pregnancy.
Conclusion
Given the importance of prenatal and postpartum care for maternal and child health
and the recent national declining trend in timely care, initiatives to improve rates
of timely and adequate care are crucial and must include components tailored toward
particularly vulnerable subpopulations.
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Biography
Sharada Weir is an Assistant Professor in the Department of Family Medicine and Community Health and Senior Project Director at the Center for Health Policy and Research, University of Massachusetts Medical School.
Biography
Heather E. Posner is a Project Associate at the Center for Health Policy and Research, University of Massachusetts Medical School.
Biography
Jianying Zhang is a Senior Biostatistician at the Center for Health Policy and Research, University of Massachusetts Medical School.
Biography
Georgianna Willis is a Project Director at the Center for Health Policy and Research, University of Massachusetts Medical School.
Biography
Jeffrey Baxter is an Assistant Professor in the Department of Family Medicine and Community Health and Research Associate at the Center for Health Policy and Research, University of Massachusetts Medical School.
Biography
Robin E. Clark is Associate Professor of Community and Family Medicine and of Quantitative Health Sciences and Director of Research and Evaluation at the Center for Health Policy and Research, University of Massachusetts Medical School.
Article info
Publication history
Published online: May 13, 2011
Accepted:
March 9,
2011
Received in revised form:
March 9,
2011
Received:
February 8,
2010
Footnotes
This manuscript is based on a project conducted in collaboration with the Office of Acute and Ambulatory Care, Executive Office of Health and Human Services (EOHHS), Commonwealth of Massachusetts.
Identification
Copyright
© 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
