Janet M. Bronstein

Late Preterm Infants: Birth Outcomes and Health Care Utilization in the First Year

OBJECTIVE: To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score–matching methods on a statewide database that contains information on both mothers and infants. METHODS: Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37–42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics. RESULTS: A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio [aOR]: 1.31 [95% confidence interval [CI]: 1.01–1.68]), respiratory distress syndrome (aOR: 2.84 [95% CI: 2.33–3.45]), and hypoglycemia (aOR: 1.60 [95% CI: 1.26–2.03]). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect:

Determinants of Rural Travel Distance for Obstetrics Care

108 [95% CI:

Bypassing Rural Hospitals for Obstetrics Care

58–

Practice variation in the use of corticosteroids: a comparison of eight data sets.

158]; inpatient,

Distributing Medical Expertise: The Evolution And Impact Of Telemedicine In Arkansas

597 [95% CI:

Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

528–

Low Prenatal Weight Gain Among Adult WIC Participants Delivering Term Singleton Infants: Variation by Maternal and Program Participation Characteristics

666]) for LPIs. CONCLUSIONS: LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.

Issues and Biases in Matching Medicaid Pregnancy Episodes to Vital Records Data: The Arkansas Experience

This study examines the distances traveled for inpatient obstetrics care by women residing in rural Alabama in 1983 and 1988. During that time 23 rural hospitals in the state stopped providing obstetrics services and mean travel distances increased by 6.8 miles. However, in 1988 50% of rural pregnant women bypassed the nearest rural hospital still providing obstetrics services. Multivariate techniques are used to examine the effects of distance and service offerings of rural hospitals and their substitutes on the actual distance traveled for care. Patient characteristics are also considered. The most important finding is that a 5% increase in per capita income in the womans home county is associated with a 20% increase in actual travel distance, other things equal. Implications for rural health policy are discussed.

Assessing the Extent of Medical Home Coverage Among Medicaid-Enrolled Children

We use data from 1983 and 1988 on hospital use in Alabama to examine the decisions of rural pregnant women to bypass the nearest rural hospital providing obstetric services and seek care elsewhere. The proportion of women who made the decision to bypass the nearest rural hospital increased from 40 percent to 45 percent between 1983 and 1988, while the proportion who traveled to metropolitan areas increased from 41 percent to 68 percent. Women with resources appear to choose longer travel distances in order to use hospitals with high birth volumes and high-risk infant services, but women from counties with large Medicaid populations also more frequently bypassed nearby hospitals.

Family planning provider referral, facilitation behavior, and patient follow-up for abnormal Pap smears.

National Institutes of Health (NIH) Consensus Development Conference, Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes, was convened to resolve ongoing uncertainties in the medical community on the benefits of administering corticosteroids to women in premature labor. Therapies with uncertain benefits tend to have more varied rates of use across small areas than therapies with established benefits.’ A recent paper on rates of use of obstetric and neonatal interventions confirmed that the use of corticosteroids is highly variable: rates of use of antenatal corticosteroids for white low birth weight infants ranged from near 0% to about 58% across 30 centers participating in the Vermont-Oxford Trials Network in 1990.’ Although random variations in the use of therapies are an indicator of differences in physician practice styles, consistent variations in rates of use provide indicators of (1) areas of agreement in use of the therapy across physicians and (2) practice contexts that either facilitate or generate obstacles to adoption of the therapy. We examined five of the multicenter data sets that were used at the NIH Consensus Conference to assess outcomes of corticosteroid use, along with three additional multicenter data sets, to identify consistencies in the pattern of use of antenatal corticosteroids in premature labor.