Background
Preterm birth is a significant clinical and public health issue in the United States.
Rates of preterm birth have remained unchanged, and racial disparities persist. Although
a causal pathway has not yet been defined, it is likely that a multitude of clinical
and social risk factors contribute to a pregnant person’s risk. State-based public
health and provider programmatic partnerships have the potential to improve care during
pregnancy and reduce complications, such as preterm birth. In North Carolina, a state-based
Medicaid-managed Pregnancy Medical Home Program screens pregnant individuals for psychosocial
and medical risk factors and utilizes community-based care management, to offer support
to those at highest risk.
Objective
This study aimed to examine the association between care-management and birth outcomes
(low birthweight and preterm birth rates) among high-risk non-Hispanic White and Black
pregnant people enrolled in the North Carolina Pregnancy Medical Home.
Study Design
This was a quasi-experimental study of people in the Medicaid-managed North Carolina
Pregnancy Medical Home who had singleton pregnancies and who enrolled in the program
between January 2016 and December 2017. Black and White pregnant people were included
in the analysis if they had singleton pregnancies, were enrolled in the Pregnancy
Medical Home, and for whom there were data regarding care management involvement.
Preterm birth and low birthweight were chosen as the outcomes of interest. Two different
methodologies were used to test the effect of care management on outcomes: Method
1 evaluated the effect of intensive care management (≥5 face-to-face visits from a
care manager) and Method 2 evaluated the effect of the implementation of a specific
risk-stratification system. Chi-squared and multivariate logistic regressions were
performed as appropriate.
Results
From January 1, 2016 to December 31, 2017, a total of 3564 singleton pregnancies occurred
among non-Hispanic Black and White pregnant Medicaid beneficiaries, who were a part
of the Pregnancy Medical Home in North Carolina. White pregnant people comprised 57%
and Black pregnant people comprised 43% of the sample. In the Method 1 analysis, intensive
care management was significantly associated with reductions in preterm birth and
low birthweight among Black and White pregnant people whereas in the Method 2 analysis,
the implementation of a risk-stratification score only resulted in a significant reduction
among Black pregnant people. In multivariable logistic modeling, race, number of prenatal
visits, and intensive care management were all significantly associated with the outcomes
of interest.
Conclusion
Care management is associated with reductions in preterm birth and low birthweight
in the Medicaid-managed Pregnancy Medical Home in North Carolina. This study contributes
to a growing body of literature on the role of state-based initiatives in reducing
perinatal morbidity. These results are significant as it demonstrates the importance
of care coordination and management, in identifying and providing resources for high-risk
pregnant people. In the United States, where pregnancy-related outcomes are poor,
programs that address the multitude of economic, social, and clinical complexities
are becoming increasingly crucial and necessary.
Key words
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Article Info
Publication History
Published online: March 09, 2022
Accepted:
March 8,
2022
Received in revised form:
March 7,
2022
Received:
December 10,
2021
Footnotes
The authors report no conflict of interest.
Cite this article as: Mallampati D, Jackson C, Menard MK. The association between care management and neonatal outcomes: the role of a Medicaid-managed pregnancy medical home in North Carolina. Am J Obstet Gynecol 2022;226:848.e1-9.
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