Karen M. Clements

Preterm Birth–Associated Cost of Early Intervention Services: An Analysis by Gestational Age

OBJECTIVES. Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. METHODS. Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for childrens first 3 years also were examined. RESULTS. Overall, 14033 of 76901 surviving infants received early intervention services. Program costs totaled almost

Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001–2005

66 million, with mean cost per surviving infant of

Using Linked Data to Assess Patterns of Early Intervention (EI) Referral among Very Low Birth Weight Infants

857. Mean cost per infant was highest for children who were 24 to 31 weeks gestational age (

Pregnancy outcomes among women with intellectual and developmental disabilities

5393) and higher for infants who were 32 to 36 weeks gestational age (

Maternal characteristics, pregnancy complications and adverse birth outcomes among women with disabilities

1578) compared with those who were born at term (

Disparities in Adverse Preconception Risk Factors Between Women with and Without Disabilities

725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants. CONCLUSIONS. Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.

Access to New Medications for Hepatitis C for Medicaid Members: A Retrospective Cohort Study

OBJECTIVE: We examined trends in autism spectrum disorder diagnoses by age 36 months (early diagnoses) and identified characteristics associated with early diagnoses. METHODS: Massachusetts birth certificate and early-intervention program data were linked to identify infants born between 2001 and 2005 who were enrolled in early intervention and receiving autism-related services before age 36 months (through December 31, 2008). Trends in early autism spectrum disorders were examined using Cochran-Armitage trend tests. χ2 Statistics were used to compare distributions of selected characteristics for children with and without autism spectrum disorders. Multivariate logistic regression analyses were conducted to identify independent predictors of early diagnoses. RESULTS: A total of 3013 children (77.5 per 10 000 study population births) were enrolled in early intervention for autism spectrum disorder by age 36 months. Autism spectrum disorder incidence increased from 56 per 10 000 infants among the 2001 birth cohort to 93 per 10 000 infants in 2005. Infants of mothers younger than 24 years of age, whose primary language was not English or who were foreign-born had lower odds of an early autism spectrum disorder diagnosis. Maternal age older than 30 years was associated with increased odds of an early autism spectrum disorder diagnosis. Odds of early autism spectrum disorders were 4.5 (95% confidence interval: 4.1–5.0) times higher for boys than girls. CONCLUSIONS: Early autism spectrum disorder diagnoses are increasing in Massachusetts, reflecting the national trend observed among older children. Linkage of early-intervention program data with population-based vital statistics is valuable for monitoring autism spectrum disorder trends and planning developmental and educational service needs.

The Effect of a Federal Controlled Substance Act Schedule Change on Hydrocodone Combination Products Claims in a Medicaid Population

ObjectivesAccess to Early Intervention (EI) services may improve cognitive and behavioral outcomes in very low birth weight infants, but few states have population-based data to evaluate EI outreach efforts. We analyzed Massachusetts (MA) infants born weighingxa0<1,200xa0g to identify maternal and birth characteristics that predicted EI referral and timing of referral.MethodsMA birth and hospital discharge records (Jan. 1998–Sept. 2000) were linked to EI referral records (Jan. 1998–Sept. 2003) via probabilistic and deterministic methods (88% linkage). Timing of EI referral among infants weighingxa0<1,200xa0g was examined by infant and maternal characteristics using categorical (0–12xa0months, 12–36xa0months, or no referral) time comparisons in the crude analysis. Survival functions calculating median time to referral, and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated for continuous time comparisons of EI referral from birth to 36xa0months.ResultsOf 1,233 infants weighingxa0<1,200xa0g, 93.2% were referred to EI. After risk adjustment, referral was more likely among multiple-birth infants (HRxa0=xa01.17, 95%CI 1.06–1.30) and less likely among infantsxa0<28xa0weeks (HRxa0=xa00.70; 95%CI 0.64–0.77) or with low Apgar scores (<5 at 5xa0min; HRxa0=xa00.75; 95%CI 0.62–0.92). EI referrals were lower for infants of black non-Hispanic mothers, and mothers without private insurance (HRxa0=xa00.85; 95%CI 0.74–0.98 and HRxa0=xa00.77; 95%CI 0.68–0.86, respectively).ConclusionsIn MA, most infants born <1,200xa0g are referred to EI, but disparities exist. Analysis of linked population-based health and developmental services can inform programs in order to reduce disparities and improve access for all high-risk infants.

Pregnancy Characteristics and Outcomes among Women at Risk for Disability from Health Conditions Identified in Medical Claims

BACKGROUNDnThere is currently no population-based research on the maternal characteristics or birth outcomes of U.S. women with intellectual and developmental disabilities (IDDs). Findings from small-sample studies among non-U.S. women indicate that women with IDDs and their infants are at higher risk of adverse health outcomes.nnnPURPOSEnTo describe the maternal characteristics and outcomes among deliveries to women with IDDs and compare them to women with diabetes and the general obstetric population.nnnMETHODSnData from the 1998-2010 Massachusetts Pregnancy to Early Life Longitudinal database were analyzed between November 2013 and May 2014 to identify in-state deliveries to Massachusetts women with IDDs.nnnRESULTSnOf the 916,032 deliveries in Massachusetts between 1998 and 2009, 703 (<0.1%) were to women with IDDs. Deliveries to women with IDDs were to those who were younger, less educated, more likely to be black and Hispanic, and less likely to be married. They were less likely to identify the father on the infants birth certificate, more likely to smoke during pregnancy, and less likely to receive prenatal care during the first trimester compared to deliveries to women in the control groups (p<0.01). Deliveries to women with IDDs were associated with an increased risk of adverse outcomes, including preterm delivery, very low and low birth weight babies, and low Apgar scores.nnnCONCLUSIONSnWomen with IDDs are at a heightened risk for adverse pregnancy outcomes. These findings highlight the need for a systematic investigation of the pregnancy-related risks, complications, costs, and outcomes of women with IDDs.

Effectiveness of Ledipasvir/Sofosbuvir and Predictors of Treatment Failure in Members with Hepatitis C Genotype 1 Infection: A Retrospective Cohort Study in a Medicaid Population

Objectives:The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. Methods:Data from the 2002–2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. Results:Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6–15.6 compared with 8.9%; 95% CI, 8.5–9.3 for women without disabilities) and low–birth-weight babies (10.3%; 95% CI, 9.4–11.2 compared with 6.8%; 95% CI, 6.8–6.9). There was no difference in the rates of cesarean section between women with and without disabilities. Conclusions:These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.