Journal article
Are Outcomes and Care Processes for Preterm Neonates Influenced by Health Insurance Status?
Pediatrics (Evanston), v 124(1), pp 122-127
01 Jul 2009
PMID: 19564291
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE: The purpose of this work was to compare the processes of care and to evaluate outcomes of premature neonates delivered to women with Medicaid managed care versus private insurance.
DESIGN/METHODS: All of the infants born at <37 weeks' gestation between January 2001 and August 2005 in the ParadigmHealth database were included in these analyses (n = 24 151). Infants were categorized by maternal health insurance status as private insurance or Medicaid managed care and analyzed for differences in demographic data and length of stay. For survivors, differences in respiratory care, nutritional, and maturational milestones were assessed. In addition, age to wean to open crib, weight gain, home oxygen, and apnea monitor use were compared. Adverse outcomes, including necrotizing enterocolitis, sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, bronchopulmonary dysplasia, apnea, and mortality, were compared. Statistical tests used were Students t test, chi(2), and Kruskall-Wallis test. Multiple logistic regression
RESULTS: Of the 24 151 infants studied, 19 046 (78.9%) had private insurance, and 5105 (21.1%) had Medicaid managed care. There were no differences in gestational age at birth; however, Medicaid managed care infants had lower birth weight, lower Apgar score at 5 minutes, increased incidence of necrotizing enterocolitis and bacterial sepsis, and longer length of stay. Of the surviving infants, more neonates with private insurance went home on oxygen and apnea monitors despite no differences found in the incidences of apnea or bronchopulmonary dysplasia between the groups. There were no differences in processes of care for feeding and respiratory milestones, but infants with Medicaid managed care weaned to an open crib later and had greater overall weight gain compared with infants with private insurance.
CONCLUSIONS: We speculate that, in addition to the known impact of insurance status on well-being at birth, Medicaid managed care is independently associated with adverse neonatal outcomes in preterm infants, as well as differences in neonatal intensive care discharge processes. Pediatrics 2009;124:122-127
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Details
- Title
- Are Outcomes and Care Processes for Preterm Neonates Influenced by Health Insurance Status?
- Creators
- Gwieneverea D. Brandon - Thomas Jefferson UniversitySusan Adeniyi-Jones - Thomas Jefferson UniversitySharon Kirkby - Alere, Upper Saddle River, NJ USADavid Webb - Drexel Univ, Coll Med, Philadelphia, PA 19104 USAJennifer F. Culhane - Drexel UniversityJay S. Greenspan - Thomas Jefferson University
- Publication Details
- Pediatrics (Evanston), v 124(1), pp 122-127
- Publisher
- Amer Acad Pediatrics
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000267448100016
- Scopus ID
- 2-s2.0-67649596080
- Other Identifier
- 991019339702904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Pediatrics