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Postpartum Screening for Diabetes among Medicaid-Eligible South Carolina Women with Gestational Diabetes

Published:October 03, 2011DOI:https://doi.org/10.1016/j.whi.2011.08.003

      Abstract

      Purpose

      To examine the rate of timely postpartum screening for diabetes among Medicaid-eligible women with gestational diabetes mellitus (GDM).

      Methods

      We examined a retrospective cohort of Medicaid women with a live birth between 2004 and 2007. Women with singleton live births at greater than 28 weeks gestation were included in the cohort and their screening receipt tracked. Only the first qualifying pregnancy within the observation period was assessed. Birth certificate records were linked with hospital discharge data, outpatient prenatal care claims to identify women with GDM (n = 6,239). Medicaid postpartum claims for these women were examined to determine receipt of postpartum screening for diabetes within 5 to 13 weeks. Women with any indication of a dedicated plasma glucose test identified by CPT codes 82947, 82950, 82951, and 82952 during this time period were considered to meet the definition of screening.

      Results

      Approximately 3.4% of women identified as having GDM were screened for diabetes postpartum. Adjusted analysis found women not attending the postpartum visit (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.37–0.91) and women receiving inadequate prenatal care (OR, 0.57; 95% CI, 0.34–0.95) were less likely to receive postpartum screening for diabetes. Conversely, women 20 to 34 years of age (OR, 1.79; 95% CI, 1.21–2.66) and women who were obese (OR, 2.28; 95% CI, 1.56–3.32) were more likely to be screened.

      Conclusions

      Medicaid is a primary source of insurance for many women; however, for most coverage ends at 60 days postpartum, leaving a narrow window of opportunity for postpartum screening. Extended periods of coverage may be beneficial in ensuring the opportunity to receive adequate postpartum care, including screening for diabetes.
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      Biography

      Nathan Hale, PhD, is a Research Assistant Professor in the Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health. Research interests include Medicaid policy and systems of care for vulnerable populations.

      Biography

      Janice C. Probst, PhD, is a Professor in the Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health. Research interests include rural heath and health care delivery systems for vulnerable populations.

      Biography

      Jihong Liu, ScD, is a Associate Professor in the Department of Epidemiology and Biostatistics at the University of South Carolina, Arnold School of Public Health. Research interests include obesity, chronic disease, and pregnancy.

      Biography

      Amy Brock Martin, DrPH, is a Research Assistant Professor in the Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health. Research interests include Medicaid policy and access to care for vulnerable populations.

      Biography

      Kevin J. Bennett, PhD, is a Assistant Professor in the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine. Research interests include with chronic disease and quality improvement.

      Biography

      Saundra Glover, PhD, is a Professor in the Department of Health Services Policy and Management at the University of South Carolina, Arnold School of Public Health. Research interests include health disparities and access to care for vulnerable populations.