Jackson-Moore Lisa, Malloy Kim, Urrutia Gene, Berg Kristen A, Miller Emily S, Boozer Margaret, Serna Tania, Bailit Jennifer L, Larkin Suzanna, Arora Kavita Shah
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA.
Center for Health Care Research & Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, OH 44106, USA.
J Natl Med Assoc. 2025 Apr;117(2):148-154. doi: 10.1016/j.jnma.2025.04.003. Epub 2025 May 23.
OBJECTIVE(S): To evaluate the association between patient demographics, clinician demographics, and concordance of patient-clinician demographics and Medicaid sterilization consent form validity, defined as the waiting period having elapsed.
Secondary analysis of a large, multi-center retrospective cohort study. This analysis included patients with Medicaid insurance desiring postpartum permanent contraception across three study sites. Our primary outcome was Medicaid sterilization consent form validity. Patient demographics were abstracted from the electronic medical record. Clinician demographics were obtained both through self- and peer-report. Descriptive, random effects modeling, and multivariable logistic regression analyses were utilized.
Of the 1644 patients delivered by 124 clinicians in our cohort, 840 (51 %) had a valid Medicaid sterilization consent form. Descriptively, patients who were Black, unmarried, and not college educated were more likely to have valid forms (p < 0.001). The religious affiliation of the clinician (p < 0.001), but no other clinician characteristics, was associated with form validity. In multivariable models, patients who were of a different racial identity than their clinicians were more likely to have a valid form (aOR 1.32, 95 % confidence interval (CI) 1.05-1.66).
CONCLUSION(S): While unable to determine the causes of our findings, the differential proportion of Medicaid sterilization consent form validity based on patient characteristics is concerning. Differences in form validity based on patient-clinician racial and ethnic concordance is deserving of further study.
评估患者人口统计学特征、临床医生人口统计学特征以及患者与临床医生人口统计学特征的一致性与医疗补助绝育同意书有效性（定义为等待期已过）之间的关联。
对一项大型多中心回顾性队列研究进行二次分析。该分析纳入了三个研究地点有医疗补助保险且希望产后采取永久避孕措施的患者。我们的主要结局是医疗补助绝育同意书的有效性。患者人口统计学特征从电子病历中提取。临床医生人口统计学特征通过自我报告和同行报告获得。采用描述性分析、随机效应模型和多变量逻辑回归分析。
在我们队列中由124名临床医生接生的1644例患者中，840例（51%）拥有有效的医疗补助绝育同意书。从描述性角度来看，黑人、未婚且未受过大学教育的患者更有可能拥有有效同意书（p<0.001）。临床医生的宗教信仰（p<0.001）与同意书有效性相关，但其他临床医生特征则不然。在多变量模型中，与临床医生种族身份不同的患者更有可能拥有有效同意书（校正比值比1.32，95%置信区间1.．05 - 1.66）。
虽然无法确定我们研究结果的原因，但基于患者特征的医疗补助绝育同意书有效性的差异比例令人担忧。基于患者与临床医生种族和民族一致性的同意书有效性差异值得进一步研究。
