Vladutiu Catherine J, Stringer Elizabeth M, Kandasamy Veni, Ruppenkamp Jill, Menard M Kathryn
Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Matern Child Health J. 2019 Feb;23(2):265-276. doi: 10.1007/s10995-018-2651-6.
Objectives To estimate the rate of pregnancy-associated emergency care visits and identify maternal and pregnancy characteristics associated with high utilization of emergency care among pregnant Medicaid recipients in North Carolina. Methods A retrospective cohort study using linked Medicaid hospital claims and birth records of 107,207 pregnant Medicaid recipients who delivered a live-born infant in North Carolina between January 1, 2008 and December 31, 2009. Rates were estimated per 1000 member months of Medicaid coverage. High utilization was defined as ≥ 4 visits. Emergency care visits included encounters in the emergency department or obstetric triage unit during pregnancy that did not result in hospital admission. Results During the study period, 57.5% of pregnant Medicaid recipients sought emergency care at least once during pregnancy. There were 171,909 emergency care visits with an overall rate of 202.3 visits per 1000 member months. Among the subset of pregnant women with Medicaid coverage for the majority of their pregnancy (n = 75,157), 18.1% were high utilizers. High emergency care utilization was associated with young age, black race, lower education, tobacco use, late preterm delivery, multifetal gestation, and having ≥ 1 comorbidity. Threatened labor and abdominal pain were the leading indications for visits. Conclusion Utilization of hospital-based emergency care services was common in this cohort of pregnant Medicaid recipients. Additional research is needed to assess the drivers for accessing care through the emergency department, and to examine differences in pregnancy outcomes and health care costs between high and low utilizers.
目的 评估与妊娠相关的急诊就诊率，并确定北卡罗来纳州接受医疗补助的孕妇中与急诊高利用率相关的孕产妇及妊娠特征。方法 一项回顾性队列研究，使用了2008年1月1日至2009年12月31日期间在北卡罗来纳州分娩活产婴儿的107,207名接受医疗补助的孕妇的医疗补助医院索赔记录和出生记录。按每1000个医疗补助参保月来估计就诊率。高利用率定义为≥4次就诊。急诊就诊包括孕期在急诊科或产科分诊单元的就诊，但未导致住院。结果 在研究期间，57.5%的接受医疗补助的孕妇在孕期至少寻求过一次急诊治疗。共有171,909次急诊就诊，总体就诊率为每1000个参保月202.3次。在孕期大部分时间都有医疗补助覆盖的孕妇亚组（n = 75,157）中，18.1%为高利用率者。急诊高利用率与年轻、黑人种族、低教育水平、吸烟、晚期早产、多胎妊娠以及有≥1种合并症有关。先兆临产和腹痛是就诊的主要原因。结论 在这组接受医疗补助的孕妇中，利用医院急诊服务很常见。需要进一步研究来评估通过急诊科就诊的驱动因素，并检查高利用率者和低利用率者在妊娠结局和医疗费用方面的差异。
