Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
Pharmaceut Med. 2021 Jan;35(1):39-47. doi: 10.1007/s40290-020-00371-8. Epub 2020 Dec 28.
Expanding our understanding of the effects of maternal medication exposure through research is a public health priority and will help inform both clinical and policy decision making, ultimately improving outcomes for pregnant women and their children.
Our objective was to describe a linked-data research platform that facilitates studies of pregnancy medication exposures and policy changes on maternal and child health outcomes.
Mothers receiving Medicaid benefits were probabilistically linked with newborns in the Tennessee Medicaid program (TennCare) through three distinct linkage processes. Medicaid claims data and state birth and fetal death certificate records (vital records) were used to identify and link potential mothers, deliveries, and newborn children. The linkage process started with the creation of a merged pool of potential mothers and eligible deliveries, which was linked to vital records and to children's records. In the last step, linked records from the preceding steps were combined into the final Mother-child linked records. For each data linkage step, rubrics and scoring systems for exact and partial matches and mismatches among key linkage fields were applied and used to examine the strength of the probabilistic linkages. Summary linkage yields for year 2013 are reported for illustration purposes.
Among the 84,253 potential deliveries, 1,761,557 eligible potential mothers, and 51,400 eligible children identified in Tennessee Medicaid records in 2013, a total of 60,265 of these records were uniquely linked to vital records, including 46,172 (77%) with linked mother-child-vital records. Among the 51,400 eligible children records identified in Tennessee Medicaid for that year, 97% (50,053) had at least one link to vital records or a mother-delivery record. In linked records, the median maternal age was 24 years, and the median gestational age was 39 weeks. About 33% of pregnant women underwent cesarean birth, and 1% of births were classified as complicated deliveries.
Supplementing existing Medicaid claims data with birth certificate records complements administrative claims information and allows for detailed assessments of pregnancy exposures and policy changes on mother and child outcomes.
通过研究扩大对母亲用药暴露影响的认识是公共卫生的当务之急，这将有助于为临床和政策决策提供信息，最终改善孕妇及其子女的结局。
我们的目标是描述一个链接数据研究平台，该平台可促进研究妊娠用药暴露和政策变化对母婴健康结局的影响。
通过三个不同的链接过程，将接受医疗补助（Medicaid）福利的母亲与田纳西州医疗补助计划（TennCare）中的新生儿进行概率性链接。医疗补助索赔数据和州出生及胎儿死亡证明记录（出生和死亡证明）用于识别和链接潜在母亲、分娩和新生儿。链接过程从创建潜在母亲和合格分娩的合并池开始，该合并池与出生和死亡证明记录以及儿童记录链接。在最后一步中，前几步的链接记录被合并到最终的母婴链接记录中。对于每个数据链接步骤，都应用了精确和部分匹配以及关键链接字段之间不匹配的分类和评分系统，并用于检查概率链接的强度。报告了 2013 年各个数据链接步骤的汇总链接率，以举例说明。
在田纳西州医疗补助记录中，2013 年有 84253 个潜在分娩、1761557 个符合条件的潜在母亲和 51400 个符合条件的儿童，共有 60265 个记录与出生和死亡证明记录唯一链接，其中 46172 个（77%）记录与链接的母婴-出生和死亡证明记录链接。在当年田纳西州医疗补助记录中识别的 51400 个符合条件的儿童记录中，97%（50053）至少与出生和死亡证明记录或母婴分娩记录有一个链接。在链接记录中，产妇的中位年龄为 24 岁，中位妊娠周数为 39 周。约 33%的孕妇行剖宫产分娩，1%的分娩被归类为复杂分娩。
将出生证明记录补充到现有的医疗补助索赔数据中，补充了行政索赔信息，并能够详细评估妊娠暴露和政策变化对母婴结局的影响。
