Perinatal outcomes following implementation of TennCare.
Context. - The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care.
- To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.
- Before and after retrospective cohort analysis.
Setting and Population
- Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare).
- Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life.
- Tennessee residents had 72 014 study births in 1993 and 72 278 in 1995, of which 37 543 (52.1%) and 35 707 (49.4%) were to women enrolled in Medicaid at delivery.
For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years).
These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women. (...)
Mots-clés Pascal : Système santé, Changement organisationnel, Evaluation performance, Soin, Périnatal, Poids naissance faible, Poids naissance très faible, Mortalité, Facteur risque, Origine maternelle, Age mère, Etude comparative, Tennessee, Etats Unis, Amérique du Nord, Amérique, Nouveau né, Homme, Femelle, Adulte
Mots-clés Pascal anglais : Health system, Organizational change, Performance evaluation, Care, Perinatal, Low birth weight, Very low birthweight, Mortality, Risk factor, Maternal origin, Maternal age, Comparative study, Tennessee, United States, North America, America, Newborn, Human, Female, Adult
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0120862
Code Inist : 002B30A01B. Création : 22/06/1998.