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29. A comparison of contraceptive services for adolescents at school-based versus community health centers in Oregon

Author

Boniface, Emily R., Rodriguez, Maria I., Heintzman, John, Knipper, Sarah H., Jacobs, Rebecca, and Darney, Blair G.

Subjects
School-based health clinics -- Comparative analysis -- Demographic aspects, Contraceptives -- Demographic aspects, Community health services -- Comparative analysis -- Demographic aspects, Business, Health care industry
Abstract

Objective: To compare Oregon school-based health centers (SBHCs) with community health centers (CHCs) as sources of adolescent contraceptive services. Data sources: Oregon electronic health record data, 2012-2016. Study design: We compared clinic-level counseling rates and long-acting reversible contraception (LARC) provision, adolescent populations served, and visit-level LARC provision time trends. We evaluated adjusted associations between LARC provision and Title X participation by clinic type. Data collection/extraction methods: We used diagnosis and procedure codes to identify contraceptive counseling and provision visits, excluding visits for adolescents not at risk of pregnancy. Principal findings: CHCs were more likely to provide LARC on-site than SBHCs (67.2% vs. 36.4%, respectively). LARC provision increased more at SBHCs (5.8-fold) than CHCs (2-fold) over time. SBHCs provided more counseling visits per clinic (255 vs. 142) and served more young and non-White adolescents than CHCs. The adjusted probability of LARC provision at Title X SBHCs was higher than non-Title X SBHCs (4.4% [3.9-4.9] vs. 1.7% [1.4-2.0]), but there was no significant association at CHCs. Conclusions: In Oregon, CHCs and SBHCs are both important sources of adolescent contraceptive services, and Title X plays a crucial role in SBHCs. Compared with CHCs, SBHCs provided more counseling, showed a larger increase in LARC provision over time, and served more younger and non-White adolescents. KEYWORDS adolescent, CHC, community health center, contraception, LARC, SBHC, school-based health center, What is known on this topic * School-based health centers (SBHCs) and community health centers (CHCs) are both sources of affordable reproductive health care for adolescents. * However, it is [...]

Published
2022
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45. Oregon's Expansion of Prenatal Care Improved Utilization Among Immigrant Women

Author

Swartz, Jonas J., Hainmueller, Jens, Lawrence, Duncan, and Rodriguez, Maria I.

Subjects
Medicaid -- Usage -- Research, Medical care utilization -- Methods -- Research, Prenatal care -- Methods -- Research, Health care industry
Abstract

Objectives To determine whether expanding Emergency Medicaid to cover prenatal care in Oregon affected maternal health outcomes for unauthorized immigrants. Methods This study takes place in Oregon from 2003 to 2015 and includes all Emergency Medicaid and Medicaid claims for women aged 12-51 with a pregnancy related claim. To isolate the effect of expanding access to prenatal care, we utilized a difference-in-differences approach that exploits the staggered rollout of the prenatal care program. The primary outcome was a composite measure of severe maternal morbidity and mortality. Additional outcomes include adequacy of prenatal care, detection of pregnancy complications and birth outcomes. Results A total of 213,746 pregnancies were included, with 35,182 covered by Emergency Medicaid, 12,510 covered by Emergency Medicaid Plus (with prenatal care), and 166,054 covered by standard Medicaid. Emergency Medicaid Plus coverage did not affect severe maternal morbidity (all pregnancies 0.05%, CI - 0.29; 0.39; high-risk pregnancies 2.20%, CI - 0.47; 4.88). The program did reduce inadequate care among all pregnancies (- 31.75%, 95% CI - 34.47; - 29.02) and among high risk pregnancies (- 38.60%, CI - 44.17; - 33.02) and increased diagnosis of gestational diabetes (6.24%, CI 4.36; 8.13; high risk pregnancies 10.48%, CI 5.87; 15.08), and poor fetal growth (7.37%, CI 5.69; 9.05; high risk pregnancies 5.34%, CI 1.00; 9.68). The program also increased diagnosis of pre-existing diabetes mellitus (all pregnancies 2.93%, CI 2.16; 3.69), hypertensive diseases of pregnancy (all pregnancies 1.28%, CI 0.52; 2.04) and a history of preterm birth (all pregnancies 0.87%, CI 0.27; 1.47). Conclusions for Practice Oregon's prenatal care expansion program produced positive effects for unauthorized immigrant women and their children., Author(s): Jonas J. Swartz [sup.1] [sup.2] , Jens Hainmueller [sup.3] [sup.4] [sup.5] , Duncan Lawrence [sup.4] , Maria I. Rodriguez [sup.2] Author Affiliations: (Aff1) 0000000122483208, grid.10698.36, Department of Obstetrics and [...]

Published
2019
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46. Pregnancy Medicaid Improvements in a Nonexpansion State After the Affordable Care Act

Author

Swartz, Jonas J., Meskey, Joseph, Stuart, Gretchen S., and Rodriguez, Maria I.

Subjects
North Carolina -- Health policy, Maternal health services -- Laws, regulations and rules -- Usage, Medicaid -- Laws, regulations and rules -- Usage, Postnatal care -- Economic aspects, Government regulation, Health, Science and technology, Patient Protection and Affordable Care Act
Abstract

One-half of women in the United States use Medicaid during pregnancy. Women living in states that did not expand Medicaid under the Patient Protection and Affordable Care Act (ACA) are at risk of losing coverage post partum. We analyzed Medicaid claims and vital statistics for the state of North Carolina for the period 2011 to 2017. North Carolina did not expand Medicaid but did alter Medicaid enrollment to meet ACA requirements. After implementation, enrollment in full Medicaid during pregnancy almost doubled, and enrollment in Medicaid for pregnant women decreased. Full Medicaid offers more comprehensive coverage and does not expire at 60 days post partum, allowing for access to crucial preventive health services including contraception and primary care. Key words: Patient Protection and Affordable Care Act; Affordable Care Act; ACA; Medicaid expansion; postpartum coverage; preventive health services; contraception https://doi.org/10.1370/afm.2615, INTRODUCTION North Carolina is one of 12 US states that has not expanded Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA), creating a coverage gap for low-income [...]

Published
2021
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