Severe Maternal Morbidity among Low-Income Patients with Hypertensive Disorders of Pregnancy.

Objective: Hypertensive disorders of pregnancy (HDP) contribute significantly to the development of severe maternal morbidities (SMM), particularly among low-income women. The purpose of the study was to explore the relationship between maternal characteristics and SMM, and to investigate if differences in SMM exist among patients with HDP diagnosis.

Study Design: This study utilized 2017 Alabama Medicaid administrative claims.

Primary care visits and ambulatory care sensitive diabetes hospitalizations among adult Alabama Medicaid beneficiaries.

Purpose: To describe patterns of care use for Alabama Medicaid adult beneficiaries with diabetes and the association between primary care utilization and ambulatory care sensitive (ACS) diabetes hospitalizations.

Methods: This retrospective cohort study analyzes Alabama Medicaid claims data from January 2010 to April 2018 for 52,549 covered adults ages 19-64 with diabetes. Individuals were characterized by demographics, comorbidities, and health care use including primary, specialty, mental health and hospital care.

Characterizing Hypertensive Disorders of Pregnancy Among Medicaid Recipients in a Nonexpansion State.

The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis.

Are community health centers' chief executive officers' compensation related to clinical performance?

Background: Most research of chief executive officer (CEO) compensation in the health care industry has been limited to hospitals. This study expands our knowledge of CEO compensation into the nonhospital areas of the industry, specifically community health centers (CHCs). CHCs are safety-net providers that are an integral part of the U.

Social support and diabetes distress among adults with type 2 diabetes covered by Alabama Medicaid.

Aims: Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self-management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress.

Methods: In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by Alabama Medicaid.

Improving perinatal regionalization: 10 years of experience with an Arkansas initiative.

Objective: To examine the impact of Antenatal and Neonatal Guidelines, Education and Learning Systems (ANGELS) on neonatal intensive care unit (NICU) preterm delivery rates.

Study Design: In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001-December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

The cultural construction of preterm birth in the United States.

This commentary explores four features of the cultural construction of pregnancy and childbirth in the United States: risk categorization as an aspect of reproductive governance, medicalization, intensive mothering with its implications for gender stratification, and the definition of personhood as beginning at conception. The cultural construction of preterm births (those that end before gestation is complete at about 37 weeks) is interwoven with beliefs about risk in pregnancy. Health risk categories overlap with socially stigmatized characteristics and behaviors, opening sub-groups of women up to intensive surveillance and control.

Health Information Technology Adoption and Clinical Performance in Federally Qualified Health Centers.

A national sample (N = 982) of federally qualified health centers (FQHCs) for the period 2011-2016 was examined regarding the relationship between the age and extent of health information technology (HIT) use and clinical performance. We found that each additional year of HIT use was associated with an approximate 4 percent increase in both process and outcome measures of clinical performance. Furthermore, FQHCs that fully adopted HIT had 7 percent higher clinical performance on hypertension control than those that did not adopt HIT.

Medicaid Expansion and Hospitalization for Ambulatory Care-Sensitive Conditions Among Nonelderly Adults With Diabetes.

Among nonelderly adults with diabetes, we compared hospitalizations for ambulatory care-sensitive conditions from 2013 (pre-Medicaid expansion) and 2014 (post-Medicaid expansion) for 13 expansion and 4 nonexpansion states using State Inpatient Databases. Medicaid expansion was associated with decreases in proportions of hospitalizations for chronic conditions (difference between 2014 and 2013 -0.17 percentage points in expansion and 0.

Why Is the U.S. Preterm Birth Rate So Much Higher Than the Rates in Canada, Great Britain, and Western Europe?

The portion of newborns delivered before term is considerably higher in the United States than in other developed countries. We compare the array of risk exposures and protective factors common to women across national settings, using national, regional, and international databases, review articles, and research reports. We find that U.

Assessing the Impact of Case Management on Medicaid Clients with Chronic Diseases.

State Medicaid programs increasingly use case management to manage enrollees with chronic conditions who may become cost intensive for the program. The authors examined the impact of Alabama Department of Public Health (ADPH)'s case management on care expenditures for Medicaid enrollees with various chronic diseases, over 2011 to 2014. The authors matched case-managed enrollees with three controls per case using health conditions and sociodemographics.

Fetal Mortality in the Delta.

Objectives: To compare the fetal mortality rate in the Delta counties of a state in the Mississippi Delta region of the United States with that of the non-Delta counties of the same state.

Methods: Hospital discharge data for maternal hospitalizations were linked to fetal death and birth certificates for 2004-2010. Data on maternal characteristics and comorbidities and pregnancy characteristics and outcomes were evaluated.

Initial Impacts of the Patient Care Networks of Alabama Initiative.

Objectives: To estimate the effects of medical home support on the use of clinical services and Medicaid expenditures.

Data Source: Medicaid claims.

Study Design: A difference-in-differences model where changes in utilization and expenditures of the intervention group are compared to changes in the nonintervention group.

The impact of the State Children's Health Insurance Program's unborn child ruling expansions on foreign-born Latina prenatal care and birth outcomes, 2000-2007.

The 2002 "unborn child ruling" resulted in State Children's Health Insurance Program (SCHIP) expansion for states to cover prenatal care for low-income women without health insurance. Foreign-born Latinas who do not qualify for Medicaid coverage theoretically should have benefited most from the policy ruling given their documented low rates of prenatal care utilization. This study compares prenatal care utilization and subsequent birth outcomes among foreign-born Latinas in six states that used the unborn child ruling to expand coverage to those in ten states that did not implement the expansion.

Time trends and payer differences in lengths of initial hospitalization for preterm infants, Arkansas, 2004 to 2010.

Objective: The objective of this study was to examine the time trend in length of stay (LOS) and explore potential differences in neonatal LOS by insurance type for preterm infants in Arkansas between 2004 and 2010.

Study Design: There were 18,712 preterm infants included in our analyses. Accelerated failure time models were used to model neonatal LOS as a function of insurance type and discharge year while adjusting for key maternal and infant characteristics, and complication/anomaly indicators.

Distributing medical expertise: the evolution and impact of telemedicine in arkansas.

Arkansas's telemedicine system has evolved since 2003 from a support mechanism for high-risk pregnancy consultations to an initiative that spans medical specialties, including asthma care, pediatric cardiology, gynecology, and mental health. The system has also expanded care to diverse populations, including incarcerated women and people with HIV/AIDS. This article describes the system's evolution, organization, and diverse activities.

Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention.

This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities.

Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine.

Objective: To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time.

Study Design: Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001-2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist.

Evaluating the effect of hospital and insurance type on the risk of 1-year mortality of very low birth weight infants: controlling for selection bias.

Objectives: We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias.

Methods: The study population was limited to singleton live birth infants having birth weight between 500 and 1500 g with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias.

Locations and outcomes of premature births in Arkansas.

Most (57.6%) of the extremely premature infants were born at a hospital without the availability of neonatal and MFM specialists, and 38.4% of the very premature were born at a hospital without a neonatologist.

Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention.

Objective: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Data Sources: A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county-level demographic and medical resource characteristics.