Parekh Natasha, Jarlenski Marian, Kelley David
University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite 933 W, Pittsburgh, PA, 15213, USA.
Health Policy Institute, University of Pittsburgh, Pittsburgh, USA.
Matern Child Health J. 2018 Mar;22(3):429-437. doi: 10.1007/s10995-017-2410-0.
Objectives Pennsylvania's maternal mortality, infant mortality, and preterm birth rates rank 24th, 35th, and 25th in the country, and are higher among racial and ethnic minorities. Provision of prenatal and postpartum care represents one way to improve these outcomes. We assessed the extent of disparities in the provision and timeliness of prenatal and postpartum care for women enrolled in Pennsylvania Medicaid. Methods We performed a cross-sectional evaluation of representative samples of women who delivered live births from November 2011 to 2015. Our outcomes were three binary effectiveness-of-care measures: prenatal care timeliness, frequency of prenatal care, and postpartum care timeliness. Pennsylvania's Managed Care Organizations (MCOs) were required to submit these outcomes to the state after reviewing administrative and medical records through a standardized, validated sampling process. We assessed for differences in outcomes by race, ethnicity, region, year, and MCO using logistic regression. Results We analyzed data for 12,228 women who were 49% White, 31% Black/African American, 4% Asian, and 15% Hispanic/Latina. Compared to Black/African American women, white and Asian women had higher odds of prenatal and postpartum care. Hispanic/Latina women had higher frequency of prenatal care than non-Hispanic women. Pennsylvania's Southeast had lower prenatal care and Northwest had lower postpartum care than other regions. Prenatal care significantly decreased in 2014 and increased in 2015. We observed differences between MCOs, and as MCO performance diminished, racial disparities within each plan widened. We explored hypotheses for observed disparities in secondary analyses. Conclusions for Practice Our data demonstrate that interventions should address disparities by race, region, and MCO in equity-promoting measures.
目标 宾夕法尼亚州的孕产妇死亡率、婴儿死亡率和早产率在全国分别排名第24位、第35位和第25位，在少数族裔中更高。提供产前和产后护理是改善这些结果的一种方式。我们评估了宾夕法尼亚医疗补助计划参保女性在接受产前和产后护理的提供情况及及时性方面的差异程度。方法 我们对2011年11月至2015年期间分娩活产的女性代表性样本进行了横断面评估。我们的结果是三项护理有效性二元指标：产前护理及时性、产前护理频率和产后护理及时性。宾夕法尼亚州的管理式医疗组织（MCOs）被要求通过标准化、经过验证的抽样过程审查行政和医疗记录后，向该州提交这些结果。我们使用逻辑回归评估了种族、民族、地区、年份和MCO在结果方面的差异。结果 我们分析了12228名女性的数据，其中49%为白人，31%为黑人/非裔美国人，4%为亚洲人，15%为西班牙裔/拉丁裔。与黑人/非裔美国女性相比，白人和亚洲女性接受产前和产后护理的几率更高。西班牙裔/拉丁裔女性的产前护理频率高于非西班牙裔女性。宾夕法尼亚州东南部的产前护理水平低于其他地区，西北部的产后护理水平低于其他地区。2014年产前护理显著下降，2015年有所增加。我们观察到不同MCO之间存在差异，并且随着MCO绩效的下降，每个计划中的种族差异扩大。我们在二次分析中探讨了观察到的差异的假设。实践结论 我们的数据表明，干预措施应在促进公平的措施中解决种族、地区和MCO方面的差异。
