Alexander G R, Hulsey T C, Foley K, Keller E, Cairns K
Department of Maternal and Child Health, University of Alabama at Birmingham 35294-0022, USA.
Matern Child Health J. 1997 Sep;1(3):139-49. doi: 10.1023/a:1026204527786.
Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation.
There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures.
Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17-0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05-2.48).
The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.
医疗补助计划下的管理式医疗计划正成为低收入孕妇常见的医疗服务来源。本研究描述了一个管理式医疗组织（MCO）为参加医疗补助计划的妇女开发的辅助产前护理服务干预措施，评估了干预服务的使用程度，并评估了该干预对产前护理参与情况的影响。
共有226名干预组妇女和258名对照组妇女，她们均为单胎活产，孕周在28至44周之间，且满足以下条件：（1）参加了MCO的医疗补助计划；（2）根据产前风险评估为高危；（3）在孕26周前开始产前护理。选择产前护理利用不足和不充分作为干预结果指标。
计划生育、产后两个月婴儿访视、产妇产后访视以及妇女、婴儿和儿童特别补充营养计划（WIC）转诊是该人群最常自行选择的干预服务；家庭健康助理和母乳喂养支持是需求最少的服务。超过90%需要计划生育或母乳喂养服务的人接受了这些服务，而超过20%的干预组拒绝了儿童保育、食品援助和家庭暴力转诊，以及家庭健康助理和戒烟服务。干预组产前护理利用不足的风险显著较低（OR = 0.32；95% CI：0.17 - 0.60），且更有可能进行密集的产前护理访视（OR = 1.61；95% CI：1.05 - 2.48）。
管理式医疗组织以具有成本效益的方式为参加医疗补助计划的人群提供持续产前护理的能力，部分取决于其开发的产前服务套餐，这些套餐能促进积极的预防性医疗保健利用行为和良好的妊娠结局。该项目的结果表明，该干预在改善产前护理利用方面是有益的。
