MEDICAID EXPANSION: IMPACT ON PREGNANCY OUTCOME AND COST

医疗补助范围扩大：对怀孕结果和费用的影响

• 批准号: 2235850
• 负责人: Laura-Mae Baldwin
• 金额: $ 42.63万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-04-01 至 1997-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2235850
• 关键词: MEDICAID; EXPANSION; IMPACT; PREGNANCY; OUTCOME

Specific Aims: This study will evaluate whether the case management and nursing, nutritional and psychosocial support service component of Washington's 1989 Medicaid expansion for pregnant women has succeeded in averting deleterious and expensive birth outcomes. Specifically, this study will 1) examine the effect of support services and case management on use of prenatal care, birth outcomes and medicaid payments, 2) explore whether the impact of these programs is greater in certain groups of women, such as teens, and 3) determine whether the more support and case management services used, the better the birth outcomes attained. Background and Significance: Despite their lack of financial barriers to care, women insured by Medicaid have higher rates of inadequate prenatal care and poor birth outcomes than privately insured women. Addressing the social service needs of low-income pregnant women has succeeded in improving birth outcomes in several small scale programs, and how is being implemented by a number of state Medicaid programs. This project will help determine whether these large scale, statewide programs can also succeed in reducing adverse birth outcomes. During this time of shrinking public resources, evaluations of the effects of existing Medicaid expansions on birth outcomes and costs will help policy makers decide whether to maintain or expand these programs. Research Design and Methods: A pre- and post-intervention study design will be the primary method used to evaluate the effects of the support service and case management programs on prenatal care use, birth outcomes and Medicaid payments. We will compare the change in the study's outcome measures before and after Washington's implementation of these programs in the Medicaid-AFDC populations of Washington and Colorado, a "control" state without support service or case management programs. The study groups will include singleton births of Washington and Colorado residents insured by the Medicaid-AFDC program during seven baseline and seven impact months. Similar analyses will be performed for subgroups of women such as teens, African-Americans and unmarried women. A secondary, cross-sectional analysis will compare the study's outcome measures among subgroups of women receiving different levels of support and case management services during the post-Medicaid expansion period in Washington State only. We will use Washington's First Steps Database, which has linked birth, fetal death and infant death records with Medicaid eligibility and claims, for the analyses of Washington's births. Co-investigators in Colorado will create a similar linked database for the analyses of Colorado's births. The intervention of interest is the support service and case management component of Washington's Medicaid expansion. The major outcomes include one measure of the use of prenatal care (percent of expected prenatal visits), two measures of birth outcome (birthweight and newborn length of stay), and four payment measures (Medicaid payment per delivery for maternal care, neonatal care, post- neonatal care, and maternal and infant care combined). We will adjust for potential confounding factors, including maternal demographics, prior pregnancy loss, preexisting medical conditions, geographic location, availability of obstetric providers and medicaid enrollment pattern in our analyses.

具体目的：本研究将评估案件管理和是否是 护理，营养和社会心理支持服务部​​分 华盛顿（Washington）1989年对孕妇的医疗补助扩张已经成功 避免有害和昂贵的生育成果。 具体来说，这是 研究将1）检查支持服务和案例管理的影响 在使用产前护理，出生结果和医疗补助付款时，2）探索 这些程序的影响在某些组中是否更大 妇女，例如青少年，3）确定是否更多的支持和案件 使用的管理服务，获得的出生结果越好。 背景和意义：尽管缺乏财务障碍 为了关心，由医疗补助保险的妇女的率较高 产前保健和出生结果差，比私人保险妇女。 满足低收入孕妇的社会服务需求 成功改善了几个小规模计划的分娩结果， 以及许多州医疗补助计划如何实施。 该项目将有助于确定这些大规模的 计划还可以成功减少不良的出生结果。 期间 这段时间萎缩了公共资源，评估的影响 现有关于出生成果和成本的医疗补助扩展将有助于政策 制造商决定是否维护或扩展这些程序。 研究设计和方法：干预前和干预后的研究设计 将是用于评估支持效果的主要方法 有关产前护理，出生结果的服务和案例管理计划 和医疗补助付款。 我们将比较研究结果的变化 华盛顿实施这些计划之前和之后的措施 在华盛顿和科罗拉多州的Medicaid-AFDC人群中，一个“控制” 没有支持服务或案例管理计划的状态。 研究 小组将包括华盛顿和科罗拉多州居民的单身人士的出生 在七个基准和七个基线期间由医疗补助AFDC计划保险 影响月。 将对女性亚组进行类似的分析 例如青少年，非裔美国人和未婚妇女。 次要 横断面分析将比较研究中研究的结果指标 获得不同水平的支持和案件的妇女亚组 在Medicaid扩建期间的管理服务 仅华盛顿州。 我们将使用华盛顿的第一步数据库， 与出生，胎儿死亡和婴儿死亡有关 医疗补助资格和主张，以分析华盛顿的出生。 科罗拉多州的共同投资者将创建一个类似的链接数据库 科罗拉多州的出生分析。 感兴趣的干预是 华盛顿医疗补助的支持服务和案例管理部分 扩张。 主要结果包括使用产前的一种方法 护理（预期产前访问的百分比），两种分娩结果 （出生和新生儿的住院时间）和四项付款措施 （医疗补助付款每交付的产妇护理，新生儿护理，后 新生儿护理以及母亲和婴儿护理的总和）。 我们将调整 对于可能的混杂因素，包括孕产妇人口统计学，先前 怀孕丧失，已经存在的医疗状况，地理位置， 产科提供者的可用性和医疗补助入学模式 我们的分析。