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Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data.
- Source :
-
Health services research [Health Serv Res] 2018 Dec; Vol. 53 Suppl 3, pp. 5260-5284. Date of Electronic Publication: 2018 Sep 10. - Publication Year :
- 2018
-
Abstract
- Objective: To describe variation in payer and outcomes in Veterans' births.<br />Data/setting: Secondary data analyses of deliveries in California, 2000-2012.<br />Study Design: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births. We calculated odds ratios (aOR) adjusted for age, race, ethnicity, education, and obstetric demographics.<br />Methods: We anonymously linked VA administrative data for all female VA enrollees with California birth records.<br />Principal Findings: From 2000 to 2012, we identified 17,495 births to Veterans. VA covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on VA health coverage had more preeclampsia (aOR 1.4, CI 1.0-1.8) and more cesarean births (aOR 1.2, CI 1.0-1.3), and, despite similar prematurity, trended toward more neonatal intensive care (NICU) admissions (aOR 1.2, CI 1.0-1.4) compared to Veterans using other (non-Medicaid) coverage. Overall, Veterans' birth outcomes (all-payer) mirrored California's birth outcomes, with the exception of excess NICU care (aOR 1.15, CI 1.1-1.2).<br />Conclusions: VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.<br /> (© Health Research and Educational Trust.)
- Subjects :
- Adult
California
Cesarean Section statistics & numerical data
Female
Gestational Age
Humans
Intensive Care Units, Neonatal statistics & numerical data
Middle Aged
Pregnancy
Pregnancy Complications epidemiology
Pregnancy Outcome epidemiology
Retrospective Studies
Risk Assessment
Socioeconomic Factors
United States
Young Adult
Delivery, Obstetric statistics & numerical data
Insurance Coverage statistics & numerical data
Insurance, Health statistics & numerical data
Maternal Health Services statistics & numerical data
Medicaid statistics & numerical data
United States Department of Veterans Affairs statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1475-6773
- Volume :
- 53 Suppl 3
- Database :
- MEDLINE
- Journal :
- Health services research
- Publication Type :
- Academic Journal
- Accession number :
- 30198185
- Full Text :
- https://doi.org/10.1111/1475-6773.13041