Interrante Julia D, Carroll Caitlin, Kozhimannil Katy B
Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, MN 55455, United States.
Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota, Minneapolis, MN 55455, United States.
Health Aff Sch. 2023 Jun 20;1(2):qxad020. doi: 10.1093/haschl/qxad020. eCollection 2023 Aug.
The postpartum period is critical for the health and well-being of birthing people, yet little is known about the range of health care services and supports needed during this time. Maternity care patients are often targeted for clinical interventions based on "low risk" or "high risk" designations, but dichotomized measures can be imprecise and may not reflect meaningful groups for understanding needed postpartum care. Using claims data from privately insured patients with childbirths between 2016 and 2018, this study identifies categories and predictors of postpartum care utilization, including the use of maternal care and other, nonmaternal, care (eg, respiratory, digestive). We then compare identified utilization-based categories with typical high- and low-risk designations. Among 269 992 patients, 5 categories were identified: (1) low use (55% of births); (2) moderate maternal care use, low other care use (25%); (3) moderate maternal, high other (8%); (4) high maternal, moderate other (7%); and (5) high maternal, high other (5%). Utilization-based categories were better at differentiating postpartum care use and were more consistent across patient profiles, compared with high- and low-risk dichotomies. Identifying categories of postpartum care need beyond a simple risk dichotomy is warranted and can assist in maternal health services research, policymaking, and clinical practice.
产后时期对分娩者的健康和福祉至关重要，但对于这一时期所需的医疗保健服务和支持的范围，人们了解甚少。产科护理患者常常根据“低风险”或“高风险”分类接受临床干预，但二分法测量可能不准确，可能无法反映出有助于理解所需产后护理的有意义的分组。本研究利用2016年至2018年间有分娩记录的私人保险患者的理赔数据，确定了产后护理利用的类别和预测因素，包括产妇护理及其他非产妇护理（如呼吸、消化方面的护理）利用情况。然后，我们将确定的基于利用情况的类别与典型的高风险和低风险分类进行比较。在269992名患者中，确定了5类：（1）低利用（占分娩人数的55%）；（2）产妇护理利用适度、其他护理利用低（25%）；（3）产妇护理适度、其他护理利用高（8%）；（4）产妇护理利用高、其他护理利用适度（7%）；（5）产妇护理利用高、其他护理利用高（5%）。与高风险和低风险二分法相比，基于利用情况的类别在区分产后护理利用方面表现更好，并且在不同患者群体中更具一致性。有必要识别出简单风险二分法之外的产后护理需求类别，这有助于产妇保健服务研究、政策制定和临床实践。
