Title

A Quantitative Evaluation of Prior Clinic Care on Prenatal Enrollment in a Medicaid-Subsidized Population

Document Type

Presentation

Publication Date

6-25-2014

Comments

Advisor: J.K. Baxter, M.D. MSc., Dept. of Obstetrics and Gynecology, Thomas Jefferson University

Abstract

The purpose of the project is to evaluate a Medicaid-insured prenatal population to quantify if pre-pregnancy encounters with our clinic promoted an earlier first trimester enrollment for the first prenatal visit, and also to measure number of prenatal visits that meet the definition of adequate care. A retrospective cohort study of an urban prenatal population with > 90% Medicaid-subsidized insurance was conducted. Women receiving prenatal care at a single institution were divided into two cohorts based on either prior clinic care or no prior clinic care. Primary data was collected for prenatal patients seen initially from Jan 1, 2013 to Dec 31, 2013. Primary outcomes included gestational age at first prenatal visit and number of total visits. Demographics included: level of education completed, spouse or partner involvement, race/ethnicity and prior mode of delivery for multiparous mothers. There was a statistically significant difference between the two cohorts in the gestational age at first prenatal visit. The t-test = .021. Cohort 1, with previous clinic care, (n=110) were first seen at 11.7 weeks gestational age. Cohort 2, without clinic care, (n=86) were first seen at 13.5 weeks (p=0.024). When stratified based on parity, the gestational ages were also statistically significant (p=0.004). Average number of prenatal visits for those seen previously was 10.4 visits for Cohort 1 and 10.0 visits for Cohort 2. (p=.21) Utilizing the Adequacy of Prenatal Care Index (APNCU) as another measure of prenatal utilization, showed a difference in the two Cohorts (65% vs. 58%) that was not statistically significant (p=0.44). Demographic variables were not statistically significant but clinically relevant differences were seen that might guide future research. Medicaid-subsidized insurance patients receiving care in the clinic prior to pregnancy were statistically more likely to enroll in prenatal care earlier in the first trimester than those without prior care. There was no difference in total number of visits between the cohorts. Non-traditional methods for enrolling patients in prenatal care should be considered.

Presentation: 31 minutes