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Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009-2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa's 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women 34 years compared to women 25-34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus., Author(s): Brittni N. Frederiksen [sup.1] [sup.2] [sup.7] , Catherine J. Lillehoj [sup.3] , Debra J. Kane [sup.1] [sup.4] , Dave Goodman [sup.5] , Kristin Rankin [sup.6] Author Affiliations: (1) Iowa [...]

Purpose In May 2012, the Association of Maternal and Child Health (MCH) Programs initiated a project to develop indicators for use at a state or community level to assess, monitor, and evaluate the application of life course principles to public health. Description Using a developmental framework established by a national expert panel, teams of program leaders, epidemiologists, and academicians from seven states proposed indicators for initial consideration. More than 400 indicators were initially proposed, 102 were selected for full assessment and review, and 59 were selected for final recommendation as Maternal and Child Health (MCH) life course indicators. Assessment Each indicator was assessed on five core features of a life course approach: equity, resource realignment, impact, intergenerational wellness, and life course evidence. Indicators were also assessed on three data criteria: quality, availability, and simplicity. Conclusion These indicators represent a major step toward the translation of the life course perspective from theory to application. MCH programs implementing program and policy changes guided by the life course framework can use these initial measures to assess and influence their approaches., Author(s): Tegan Callahan[sup.1] , Caroline Stampfel[sup.2] , Andria Cornell[sup.2] , Hafsatou Diop[sup.3] , Debora Barnes-Josiah[sup.4] , Debra Kane[sup.5] [sup.6] , Sarah Mccracken[sup.7] , Patricia McKane[sup.8] , Ghasi Phillips[sup.5] [sup.9] , [...]

The Iowa Department of Public Health annually links Medicaid claims data to the birth certificate. Because the latest version of the birth certificate provides more timely and less costly information on delivery payment source, we were interested in assessing the validity and reliability of the birth certificate payment source compared to Medicaid paid claims. We linked Medicaid paid claims to birth certificates for calendar years 2007-2009 (n = 120,626). We measured reliability by Kappa statistic and validity by sensitivity, specificity, predictive value positive and negative. We examined reliability and validity overall and by maternal characteristics (e.g. age, race, ethnicity, education). The Kappa statistic for the birth certificate payment source indicated substantial agreement (0.78; 95% CL 0.78-0.79). Sensitivity and specificity were also high, 86.3% (95% CL 86.0-86 6%) and 91.9% (95% CL 91.7-92.1%), respectively. The predictive value positive was 87.0%. The predictive value negative was 91.4%. Kappa and specificity were lower among women of racial and ethnic minorities, women younger than age 24, and women with less education. The overall Kappa, sensitivity and specificity generally suggest the birth certificate payment source is as valid and reliable as the linked data source. The birth certificate payment source is less valid and reliable for women of racial and ethnic minorities, women younger than age 24, and those with less education. Consequently caution should be exercised when using the birth certificate payment source for monitoring service use by the Medicaid population within specific population subgroups. Keywords Medicaid * Paid claims * Birth certificate data * Validity * Reliability * Kappa statistic * Sensitivity, Introduction Nearly 99% of births in the United States are registered by birth certificate [1]. For this reason, the birth certificate serves as a critical source of ongoing population-based data. [...]

To assess whether a measure of prenatal case management (PCM) dosage is more sensitive than a dichotomous PCM exposure measure when evaluating the effect of PCM on low birthweight (LBW) and preterm birth (PTB). We constructed a retrospective cohort study (N = 16,657) of Iowa Medicaid-insured women who had a singleton live birth from October 2005 to December 2006; 28% of women received PCM. A PCM dosage measure was created to capture duration of enrollment, total time with a case manager, and intervention breadth. Propensity score (PS)-adjusted odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated to assess the risk of each outcome by PCM dosage and the dichotomous PCM exposure measure. PS-adjusted ORs of PTB were 0.88 (95% CI 0.70-1.11), 0.58 (95% CI 0.47-0.72), and 1.43 (95% CI 1.23-1.67) for high, medium, and low PCM dosage, respectively. For LBW, the PS-adjusted ORs were 0.76 (95% CI 0.57-1.00), 0.64 (95% CI 0.50-0.82), and 1.36 (95% CI 1.14-1.63), for high, medium, and low PCM dosage, respectively. The PCM dichotomous participation measure was not significantly associated with LBW (OR = 0.95, 95% CI 0.82-1.09) or PTB (0.97, 95% CI 0.87-1.10). The reference group in each analysis is No PCM. PCM was associated with a reduced risk of adverse pregnancy outcomes for Medicaid-insured women in Iowa. PCM dosage appeared to be a more sensitive measure than the dichotomous measure of PCM participation. Keywords Prenatal case management * Prenatal home visiting * Birth outcomes * Dose-response relationships, Introduction Over the years, numerous evaluations of prenatal case management (PCM) have been conducted. PCM is a community-based health related service offered to medically and/or socially vulnerable pregnant women to [...]

A study was conducted to examine the relationship between receipt of dental care and receipt of routine medical care among children with special health care needs (CSHCN). Findings indicate that failure to obtain regular medical care may be a risk factor for failure to obtain dental care. Results also show that income below 400% of the federal poverty guidelines seems to be a barrier for receiving dental care for CSHCN.

Objectives The Iowa Department of Public Health I-Smile program provides dental screening and care coordination to over 23,000 low-income and Medicaid-enrolled children per year. The purposes of this study were to evaluate I-Smile program effectiveness to ensure that Medicaid-enrolled children obtained dental treatment after having been screened and to determine the factors associated with failure to receive dental care after screening through the I-Smile program. Methods Based on I-Smile program priorities, we limited our sample to children younger than 12 years of age who screened positive for decay and who linked to a paid Medicaid claim for dental treatment ( n = 1,816). We conducted bivariate analyses to examine associations between children's characteristics who screened positive for decay and received treatment within 6 months of their initial screening. We also performed multivariate logistic regression to assess the association of sociodemographic characteristics with receipt of treatment among children who screened positive for decay. Results Eleven percent of children screened positive for decay. Nearly 24 percent of children with decay received treatment based on a Medicaid-paid claim. Being 5 years or older [adjusted odds ratio (aOR): 1.48, confidence interval (CI): 1.17, 1.88] and not having a dental home (aOR: 1.90, CI: 1.41, 2.58) were associated with higher odds of not receiving dental treatment. Conclusions Children 5 years and older and without a dental home were less likely to obtain dental treatment. Opportunities exist for the I-Smile program to increase the numbers of at-risk children with dental homes and who obtain dental care after screening. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study was to examine comprehensive prenatal case management programs in terms of organizational, program, and process characteristics. Data from 66 program surveys of government agencies were used. Organizational capacity was measured as extent of organizational change and extent of interagency agreements. Program data included age and size of the program, reasons for having case management, and funding diversity. Process data were eight types of interventions. The most highly rated reason for having case management was to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with other agencies were rare. Agencies with more interagency contacts reported higher levels of change in the case management department and turnover among mid-level managers. Older programs had fewer employees. Approximately 49% of client contacts were not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive case management. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal case management should focus on cross-level questions. [ABSTRACT FROM AUTHOR]

Ensuring access to contraceptive services is an important strategy for preventing unintended pregnancies, which account for nearly one half of all U.S. pregnancies (1) and are associated with adverse maternal and infant health outcomes (2). Equitable, person-centered contraceptive access is also important to ensure reproductive autonomy (3). Behavioral Risk Factor Surveillance System (BRFSS) data collected during 2017-2019 were used to estimate the proportion of women aged 18-49 years who were at risk for unintended pregnancy* and had ongoing or potential need for contraceptive services. † During 2017-2019, in the 45 jurisdictions § from which data were collected, 76.2% of women aged 18-49 years were considered to be at risk for unintended pregnancy, ranging from 67.0% (Alaska) to 84.6% (Georgia); 60.7% of women had ongoing or potential need for contraceptive services, ranging from 45.3% (Puerto Rico) to 73.7% (New York). For all jurisdictions combined, the proportion of women who were at risk for unintended pregnancy and had ongoing or potential need for contraceptive services varied significantly by age group, race/ethnicity, and urban-rural status. Among women with ongoing or potential need for contraceptive services, 15.2% used a long-acting reversible method (intrauterine device or contraceptive implant), 25.0% used a short-acting reversible method (injectable, pill, transdermal patch, or vaginal ring), and 29.5% used a barrier or other reversible method (diaphragm, condom, withdrawal, cervical cap, sponge, spermicide, fertility-awareness-based method, or emergency contraception). In addition, 30.3% of women with ongoing or potential need were not using any method of contraception. Data in this report can be used to help guide jurisdictional planning to deliver contraceptive services, reduce unintended pregnancies, ensure that the contraceptive needs of women and their partners are met, and evaluate efforts to increase access to contraception., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.