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- Title
Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data.
- Authors
Shaw, Jonathan G.; Joyce, Vilija R.; Schmitt, Susan K.; Frayne, Susan M.; Shaw, Kate A.; Danielsen, Beate; Kimerling, Rachel; Asch, Steven M.; Phibbs, Ciaran S.
- Abstract
<bold>Objective: </bold>To describe variation in payer and outcomes in Veterans' births.<bold>Data/setting: </bold>Secondary data analyses of deliveries in California, 2000-2012.<bold>Study Design: </bold>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.<bold>Methods: </bold>We anonymously linked VA administrative data for all female VA enrollees with California birth records.<bold>Principal Findings: </bold>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).<bold>Conclusions: </bold>VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.
- Subjects
CALIFORNIA; UNITED States; PREGNANCY complications; OBSTETRICAL emergencies; MEDICAL care; UNITED States. Dept. of Veterans Affairs; HEALTH equity; INSURANCE statistics; HEALTH insurance statistics; MEDICAID statistics; CESAREAN section; COMPARATIVE studies; DELIVERY (Obstetrics); GESTATIONAL age; MATERNAL health services; RESEARCH methodology; EVALUATION of medical care; MEDICAL cooperation; NEONATAL intensive care; PREGNANCY; RESEARCH; RESEARCH funding; RISK assessment; SOCIOECONOMIC factors; EVALUATION research; NEONATAL intensive care units; RETROSPECTIVE studies
- Publication
Health Services Research, 2018, Vol 53, p5260
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.13041