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1.
Matern Child Health J ; 25(3): 428-438, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33523347

RESUMO

OBJECTIVE: To compare two data sources from Wisconsin-Medicaid claims and Pregnancy Risk Assessment Monitoring System (PRAMS) surveys-for measuring postpartum care utilization and to better understand the incongruence between the sources. METHODS: We used linked Medicaid claims and PRAMS surveys of Wisconsin residents who delivered a live birth during 2011-2015 to assess women's postpartum care utilization. Three different definitions of postpartum care from Medicaid claims were employed to better examine bundled service codes and timing of care. We used one question from the PRAMS survey that asks women if they have had a postpartum checkup. Concordance between the two data sources was examined using Cohen's Kappa value. For women who reported having a postpartum checkup on PRAMS but did not have a Medicaid claim for a traditional postpartum visit, we determined the other types of health care visits these women had after delivery documented in the Medicaid claims. RESULTS: Among the 2313 women with a Medicaid-paid delivery and who completed a PRAMS survey, 86.6% had claims for a postpartum visit during the first 12 weeks postpartum and 90.5% self-reported a postpartum checkup on PRAMS (percent agreement = 79.9%, Kappa = 0.015). The percent agreement and Kappa values varied based on the definition of postpartum care derived from the Medicaid claims data. CONCLUSIONS: There was slight agreement between Medicaid claims and PRAMS data. Most women had Medicaid claims for postpartum care at some point in the first 12 weeks postpartum, although the timing of these visits was somewhat unclear due to the use of bundled service codes.


Assuntos
Medicaid , Cuidado Pós-Natal , Feminino , Humanos , Período Pós-Parto , Gravidez , Medição de Risco , Estados Unidos , Wisconsin
2.
Matern Child Health J ; 24(9): 1138-1150, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32335806

RESUMO

OBJECTIVE: To compare patterns of routine postpartum health care utilization for women in Wisconsin with continuous Medicaid eligibility versus pregnancy-only Medicaid METHODS: This analysis used Medicaid records and linked infant birth certificates for Medicaid paid births in Wisconsin during 2011-2015 (n = 105,718). We determined if women had continuous or pregnancy-only eligibility from the Medicaid eligibility file. We used a standard list of billing codes to identify if women received routine postpartum care. We examined maternal characteristics and receipt of postpartum care overall and by Medicaid eligibility category. Finally, we used a binomial model to calculate the relationship between Medicaid eligibility category and receipt of postpartum care, adjusted for maternal characteristics. RESULTS: Women with continuous Medicaid had profiles more consistent with low postpartum visit attendance rates (e.g., younger, more likely to use tobacco) than women with pregnancy-only Medicaid. However, after adjusting for maternal characteristics, women with continuous Medicaid eligibility had a postpartum visit rate that was 6 percentage points higher than the rate for women with pregnancy-only Medicaid (RD: 6.27, 95% CI 5.72, 6.82). CONCLUSIONS FOR PRACTICE: Women with pregnancy-only Medicaid were less likely to have received routine postpartum care than women with continuous Medicaid. Medicaid coverage beyond the current guaranteed 60 days postpartum could help provide more women access to postpartum care.


Assuntos
Definição da Elegibilidade , Revisão da Utilização de Seguros/estatística & dados numéricos , Cobertura do Seguro , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/economia , Adulto , Declaração de Nascimento , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Medicaid/economia , Gravidez , Estados Unidos , Wisconsin
3.
WMJ ; 116(5): 215-220, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29357211

RESUMO

INTRODUCTION: Severe maternal morbidities include 25 complications resulting from, or exacerbated by, pregnancy. Nationally, in the last decade, these rates have doubled. OBJECTIVE: This study describes trends in the rates of severe maternal morbidities at the time of hospitalization for delivery among different groups of Wisconsin women. METHODS: Hospital discharge data and ICD-9-CM diagnosis and procedure codes were used to identify delivery hospitalizations and rates of severe maternal morbidity among Wisconsin women from 2000 to 2014. Subsequent analyses focused on recent years (2010-2014). Rates of severe maternal morbidity were calculated per 10,000 delivery hospitalizations for all 25 severe maternal morbidity conditions as well as 24 conditions (excluding blood transfusions). Rates and rate ratios were calculated overall and for racial/ethnic groups, age groups, public health region of residence, and hospital payer. Median hospital length of stay and median hospital charges were compared for delivery hospitalizations with increasing severe maternal morbidities. RESULTS: Severe maternal morbidity rates increased 104% from 2000 to 2014 (P for trend <0.01). After excluding blood transfusions, rates increased 15% (P for trend <0.05). From 2010 to 2014, overall rates were stable over time, but varied by maternal age, race/ethnicity, payer, and public health region of residence. Median hospital charges and length of stay increased as the number of morbidities increased. CONCLUSIONS: Monitoring severe maternal morbidities adds valuable information to understanding perinatal health and obstetric complications in order to identify opportunities for prevention of severe morbidities and improvements in the quality of maternity care.


Assuntos
Parto Obstétrico , Hospitalização/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Feminino , Humanos , Morbidade , Obstetrícia , Gravidez , Wisconsin/epidemiologia
4.
J Community Health ; 41(2): 282-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26433724

RESUMO

Old Order Amish and Mennonites, or Plain populations, are a growing minority in North America with unique health care delivery and access challenges coupled with higher frequencies of genetic disorders. The objective of this study was to determine newborn screening use and attitudes from western Wisconsin Plain communities. A cross-sectional survey, with an overall response rate of 25 %, provided data representing 2010 children. In households with children (n = 297), the rate of newborn screening was 74 % and all children were screened in 40 % of these households. Lack of access to testing was the most common reason for not screening all children and parental age was inversely associated with testing. The majority of respondents reported some or more knowledge of screening, viewed screening as important, and had access to screening in their communities. Households with children who had never received newborn screening (26 %) reported lower frequencies of favorable responses in all categories compared to households that had at least one child screened. The difference in access to newborn screening was less marked between the groups compared to differences on knowledge and consideration of its importance. Moreover, 55 % of households who had never screened any of their children reported being unlikely or unsure of screening any future children. A focus on improving access to newborn screening alongside establishing approaches to change parental perceptions on the importance of newborn screening is necessary for increasing newborn screening in these Plain communities.


Assuntos
Amish , Doenças Genéticas Inatas/diagnóstico , Testes Genéticos , Estudos Transversais , Humanos , Recém-Nascido , Medicina Preventiva , Inquéritos e Questionários , Wisconsin
5.
WMJ ; 114(5): 202-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26726341

RESUMO

INTRODUCTION: Maternal mortality is a key indicator of maternal health and the general state of health care. This report summarizes maternal deaths in Wisconsin from January 2006 through December 2010. METHODS: Maternal deaths were identified using death certificates and supporting links with infant birth and fetal death certificates. Suspected pregnancy-related maternal deaths were abstracted by a Wisconsin Maternal Mortality Review Team nurse abstractor. The entire team reviewed and analyzed these cases. If the death was deemed pregnancy related, a cause of death was determined, potential factors of avoidability were assessed, and recommendations for possible quality improvement were made. RESULTS: Fifty cases were reviewed and 21 cases were determined to be pregnancy related. The Wisconsin pregnancy-related maternal mortality ratio was 5.9 deaths per 100,000 live births (3.9-9.0, 95% CI), with markedly higher rates for non-Hispanic black women. The most common cause of death was cardiovascular related, with 5 of the 7 deaths being ascribed to peripartum cardiomyopathy. Chronic medical problems were associated with 55% of pregnancy-related maternal deaths excluding obesity. Nineteen percent of the pregnancy-related deaths reviewed were considered to be avoidable, and almost half (48%) had substantive recommendations made to improve maternal health. CONCLUSION: Even though the Wisconsin pregnancy-related maternal mortality ratio is well below the national average, there remain stark racial disparities in maternal deaths and a number of avoidable pregnancy-related deaths that should be targeted for prevention.


Assuntos
Mortalidade Materna/tendências , Complicações na Gravidez/mortalidade , Adolescente , Adulto , Causas de Morte , Atestado de Óbito , Feminino , Humanos , Gravidez , Fatores de Risco , Wisconsin/epidemiologia
6.
Matern Child Health J ; 18(2): 423-30, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23381870

RESUMO

Turning a ship requires small but steady and deliberate efforts over time. During the past 9 years, Wisconsin's Maternal and Child Health (MCH) Program has begun to utilize the life-course perspective as its framework for guiding efforts around women's health, early childhood systems, children and youth with special health care needs, chronic disease integration, and elimination of racial and ethnic disparities in birth outcomes. In collaboration with many state and national partners, Wisconsin's MCH Program has integrated the life-course perspective into efforts that include the following: increasing professional and public awareness of the framework; creating focus groups and social marketing campaigns in communities most affected by health disparities; expanding preconception and women's health initiatives; integrating with traditionally "non-MCH" programs such as chronic disease programs; and shifting Title V resources from provision of individual services to assurance of effective early childhood systems. Wisconsin's implementation of the life-course perspective has not been without challenges, but opportunities have also been identified along the journey. Initial efforts focused on training and supporting partners in their understanding and application of the life-course framework, and a train-the-trainer model was discovered to be key to achieving these goals. We took care to engage special populations and their advocates and to work closely with local communities. We hope that the lessons we have learned in this process will provide guidance for others as they work to incorporate life course into their MCH work. The life-course perspective has helped us to inform partners, policy makers, and funders of the need for a new approach in addressing racial and ethnic disparities in health.


Assuntos
Redes Comunitárias/organização & administração , Disparidades nos Níveis de Saúde , Mortalidade Infantil/etnologia , Bem-Estar do Lactente/etnologia , Serviços de Saúde Materna/organização & administração , Resultado da Gravidez/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Redes Comunitárias/normas , Redes Comunitárias/tendências , Saúde da Família/etnologia , Saúde da Família/tendências , Feminino , Grupos Focais , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/organização & administração , Humanos , Lactente , Mortalidade Infantil/tendências , Bem-Estar do Lactente/tendências , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/tendências , Cuidado Pré-Concepcional/organização & administração , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/tendências , Gravidez , Marketing Social , Wisconsin/epidemiologia
7.
Matern Child Health J ; 16 Suppl 2: 258-67, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23160762

RESUMO

The association among rural-urban communities, neighborhood characteristics, and youth physical activity is inconsistent in the literature. We used data from the 2007 National Survey of Children's Health, for youth aged 10-17 years (n = 45,392), to examine the association between physical activity and neighborhood characteristics, after adjusting for known confounders. We also examined the association between physical activity and neighborhood characteristics within seven levels of Rural-Urban Commuting Areas (RUCAs) that depict a continuum from isolated rural to dense urban communities. Attainment of a minimum physical activity level differed by RUCA (P = 0.0004). In adjusted, RUCA-specific models, the presence of parks was associated with attaining a minimum physical activity level in only one of the seven RUCAs (adjusted odds ratio: 3.49; 95 % confidence interval: 1.55, 7.84). This analysis identified no association between youths' minimum physical activity attainment and neighborhood characteristics in unstratified models; and, RUCA-specific models showed little heterogeneity by rural-urban community type. Although this analysis found little association between youth physical activity and neighborhood characteristics, the findings could reflect the crude categorization of the neighborhood amenities (sidewalks, parks, recreation centers) and detracting elements (litter, dilapidated housing, vandalism) and suggests that simple measurement of the presence of an amenity or detracting element is insufficient for determining potential associations with reaching minimum levels of physical activity. By exploring neighborhood characteristics and features of neighborhood amenities within the context of well-defined community types, like RUCAs, we can better understand how and why these factors contribute to different levels of youth physical activity.


Assuntos
Comportamentos Relacionados com a Saúde , Atividade Motora , Características de Residência/estatística & dados numéricos , População Rural/estatística & dados numéricos , Meios de Transporte , População Urbana/estatística & dados numéricos , Adolescente , Criança , Intervalos de Confiança , Estudos Transversais , Exercício Físico , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Vigilância da População , Meio Social , Fatores Socioeconômicos , Estados Unidos
8.
J Womens Health (Larchmt) ; 31(2): 158-166, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34967671

RESUMO

Background: Postpartum depression (PPD) is a serious public health crisis disproportionately affecting women of color. We examine whether interpersonal racial discrimination is associated with higher odds of postpartum depressive symptoms (PPDS) among women of color and how it may vary by race/ethnicity and maternal educational attainment. Materials and Methods: We present a secondary analysis of cross-sectional data from Pregnancy Risk Assessment Monitoring System (PRAMS) postnatal surveys conducted in nine jurisdictions between 2012 and 2015 that included a question about being upset by experiences of racial discrimination within 12 months before giving birth. Results: Being upset by racial discrimination was associated with nearly three times higher odds of PPDS. Among women of color with at least some college education, the higher odds of PPDS associated with racial discrimination were greater than threefold, and for women with less than a high school education were less than twofold. Conclusion: Addressing risk factors for PPD, including racial discrimination, may inform strategies to reduce racial disparities in maternal mental health.


Assuntos
Depressão Pós-Parto , Racismo , Estudos Transversais , Depressão , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Período Pós-Parto , Gravidez , Medição de Risco
9.
Prev Chronic Dis ; 8(4): A73, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21672397

RESUMO

INTRODUCTION: Recent initiatives aim to improve public awareness of health disparities. However, little research has actually documented the US public's awareness of racial/ethnic and socioeconomic health disparities. We sought to determine 1) whether the US public is aware of racial, educational, and income disparities in health, 2) whether awareness differs across these disparity domains, and 3) what respondent characteristics are associated with awareness of racial, educational, and income disparities in health. METHODS: We conducted the National Opinion Survey on Health and Health Disparities with 2,791 US adults. We asked respondents to answer questions about disparities in health between 1 of several pairs of population subgroups: African Americans versus whites, non-high school graduates versus high school graduates, high school graduates versus college graduates, the poor versus the middle class, or the middle class versus the rich. We used χ(2) tests and logistic regression to compare correlates of respondents' awareness of disparities across the different pairs of population subgroups. RESULTS: Most respondents were aware of health disparities between the poor and middle class (73%); fewer were aware of health disparities between African Americans and whites (46%). Although respondents recognized that education is associated with many positive life outcomes, they were less aware of the link between education and health. Respondents who were younger, less educated, lower-income, healthier, or politically conservative were less likely to be aware of health disparities. CONCLUSION: Public awareness of disparities in health differs depending on both the type of disparity and the characteristics of the individual respondent.


Assuntos
Conscientização , Negro ou Afro-Americano/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Vigilância da População/métodos , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
10.
Prev Chronic Dis ; 7(1): A16, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20040231

RESUMO

Report cards are widely used in health for drawing attention to performance indicators. We developed a state health report card with separate grades for health and health disparities to generate interest in and awareness of differences in health across different population subgroups and to identify opportunities to improve health. We established grading curves from data for all 50 states for 2 outcomes (mortality and unhealthy days) and 4 life stages (infants, children and young adults, working-age adults, and older adults). We assigned grades for health within each life stage by sex, race/ethnicity, socioeconomics, and geography. We also assigned a health disparity grade to each life stage. Report cards can simplify complex information for lay audiences and garner media and policy maker attention. However, their development requires methodologic and value choices that may limit their interpretation.


Assuntos
Administração em Saúde Pública/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Educação , Feminino , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde , Programas Gente Saudável , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Vigilância da População , Administração em Saúde Pública/estatística & dados numéricos , Grupos Raciais , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
11.
J Public Health Manag Pract ; 15(1): 24-32, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19077591

RESUMO

BACKGROUND: Assessment is a core function of public health; however, standard community health assessments often remain within the boundaries of the traditional public health system and rarely elicit public discussion and community-wide action. The University of Wisconsin Population Health Institute developed the annual Wisconsin County Health Rankings (Rankings) report in 2003 with three primary goals: (1) to increase media attention to local health outcomes and determinants; (2) to highlight the broad range of factors that influence health; and (3) to catalyze community health improvement efforts. METHODS: We assessed how well the Rankings met these goals through an examination of media coverage and a survey of the local public health community following the 2006 report. FINDINGS: Newspaper, television, and radio media across the state covered the Rankings, highlighting local results for outcomes and a broad range of determinants. Local public health officials used the Rankings for educating policy makers and community partners, performing needs assessments, and identifying program targets. CONCLUSIONS: The Rankings report is an approach to community health assessment that has received media attention and been found to be useful by local public health officials in their community health improvement efforts.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Indicadores Básicos de Saúde , Disseminação de Informação , Meios de Comunicação de Massa , Saúde Pública , Wisconsin
12.
WMJ ; 118(3): 126-131, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682748

RESUMO

OBJECTIVE: To assess provider practice patterns on type of progesterone prescribed and barriers specific to 17 α-hydroxyprogesterone caproate utilization for preterm birth prevention. STUDY DESIGN: A survey mailed to providers assessed utilization and barriers to long-acting reversible contraception and progesterone for preterm birth prevention. Data analysis included chi-square tests for homogeneity followed by post hoc tests of proportions to detect significant pairwise differences. RESULTS: Five hundred sixty-three of 1,695 respondents who provide prenatal care were included in the analysis. More obstetric than family medicine and midwife providers (87.4% vs 31.4% and 72.6%, respectively; P < .001) prescribed any progesterone for preterm birth prevention. More obstetric providers prescribed 17a-hydroxyprogesterone caproate (17OHP-C) compared with family medicine and midwife providers (98.1% vs 77.8% and 80.5%, respectively; P < .0001). Family medicine and midwife providers prescribed oral progestertone more often than obstetric providers (40.7% and 24.4% vs 13.1 %; P < .05). System-level barriers to 17OHP-C were reported more often than patient-level barriers at a rate that was highest among family medicine and midwife providers. CONCLUSION: 17OHP-C has been demonstrated to be an effective method for prevention of recurrent preterm birth. It is used significantly less-and oral progesterone is used significantly more-by family medicine and midwife providers, emphasizing the need for increased education and decreased treatment barriers for its utilization for preterm birth prevention.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Nascimento Prematuro/prevenção & controle , Progesterona/administração & dosagem , Adulto , Feminino , Humanos , Gravidez , Inquéritos e Questionários , Wisconsin
13.
Public Health Rep ; 134(1): 17-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30508497

RESUMO

INTRODUCTION: Mental health and substance use are growing public health concerns, but established surveillance methods do not measure the burden of these conditions among women of reproductive age. We developed a standardized indicator from administrative data to identify inpatient hospitalizations related to mental health or substance use (MHSU) among women of reproductive age, as well as co-occurrence of mental health and substance use conditions among those hospitalizations. MATERIALS AND METHODS: We used inpatient hospital discharge data from 2012-2014 for women aged 15-44 residing in Illinois and Wisconsin. We identified MHSU-related hospitalizations through the principal International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and first-listed ICD-9-CM external cause of injury code (E code). We classified hospitalizations as related to 1 of 3 mutually exclusive categories: a mental disorder, a substance use disorder, or an acute MHSU-related event. We defined co-occurrence as the presence of both mental health and substance use codes in any available diagnosis or E-code field. RESULTS: Of 1 173 758 hospitalizations of women of reproductive age, 150 318 (12.8%) were related to a mental disorder, a substance use disorder, or an acute MHSU-related event, for a rate of 135.6 hospitalizations per 10 000 women. Of MHSU-related hospitalizations, 115 163 (76.6%) were for a principal mental disorder, 22 466 (14.9%) were for a principal substance use disorder, and 12 709 (8.5%) were for an acute MHSU-related event; 42.4% had co-occurring mental health codes and substance use codes on the discharge record. PRACTICE IMPLICATIONS: MHSU-related disorders and events are common causes of hospitalization for women of reproductive age, and nearly half of these hospitalizations involved co-occurring mental health and substance use diagnoses or events. This new indicator may improve public health surveillance by establishing a systematic and comprehensive method to measure the burden of MHSU-related hospitalizations among women of reproductive age.


Assuntos
Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Codificação Clínica , Feminino , Humanos , Illinois/epidemiologia , Pacientes Internados , Alta do Paciente/estatística & dados numéricos , Saúde Pública , Wisconsin , Adulto Jovem
14.
WMJ ; 107(3): 124-30, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18575096

RESUMO

OBJECTIVE: There is increasing evidence about the importance of factors that impact health beyond health care and individual behavior, yet there is little public and policy discourse about these things in the United States. We surveyed Wisconsin adults to see what they think are the most important factors that affect health. We also examined which interventions they believe would improve health, and whether government should prioritize such interventions. METHODS: A phone survey of a random sample of 1459 Wisconsin adults was conducted between September 2006 and February 2007. RESULTS: The Wisconsin public believes that health practices, access to health care, and health insurance are the most important factors affecting health, and that health insurance is a high government priority. Other broader social and economic determinants of health, such as employment, social support, income, housing, and neighborhood factors are seen as less important to health. Although respondents believe that health practices are important to health, they are less likely to suggest that government prioritize improving individual health practices. Although the public believes the government should prioritize access to health care and health insurance, they are not as likely to support government implementing social or economic policies in order to improve health. CONCLUSION: In light of research demonstrating the importance of social and economic determinants of health, and of ongoing public forums meant to raise awareness of these determinants of health, it will be important to track whether public opinion of Wisconsin adults changes over time to increase attention to the social and economic determinants of health and related policy initiatives.


Assuntos
Prioridades em Saúde , Acessibilidade aos Serviços de Saúde , Indicadores Básicos de Saúde , Opinião Pública , Adolescente , Adulto , Idoso , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Wisconsin
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