TY - JOUR
T1 - Factors Associated With Postpartum Diabetes Screening in Women With Gestational Diabetes and Medicaid During Pregnancy
AU - Herrick, Cynthia J.
AU - Keller, Matthew R.
AU - Trolard, Anne M.
AU - Cooper, Ben P.
AU - Olsen, Margaret A.
AU - Colditz, Graham A.
N1 - Funding Information:
CJH is currently funded on a career development award (K23HD096204) from the National Institutes of Child Health and Development. MAO and MRK are funded by the Center for Administrative Data Research, which is supported in part by the Washington University Institute of Clinical and Translational Sciences Grant UL1 TR002345 from the National Center for Advancing Translational Sciences and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality. CJH received an honorarium for speaking at the annual meeting of the Missouri Primary Care Association in October 2018 and October 2019. MAO receives grant funding from Pfizer, Sanofi Pasteur, and Merck and provides consultation services for Pfizer. BPC was previously employed by the Centene Corporation. No other financial disclosures were reported.
Funding Information:
The investigators would like to acknowledge Susan Wilson, MBA (former COO), Joe Pierle, MPA (CEO), Sam Joseph, PA (Center for Healthcare Quality Director), and all member health centers of the Missouri Primary Care Association for their support in facilitating this study's implementation. The authors would like to acknowledge Jeff Brandes, BS and Philip Parker, MBA at Azara Healthcare for their assistance in electronic health record data extraction. The authors would like to acknowledge Jill Lucht, MS and Bhawani Mishra, PhD at the Center for Health Policy at the University of Missouri (St. Louis, MO) for linking identifiers transferred from Azara Healthcare to Medicaid administrative claims and Paul Stuve, PhD and others at MO Health Net for providing access to Medicaid claims data and reviewing the manuscript. Finally, the authors would like to acknowledge Bethany Johnson-Javois, MSW, Jane Schaefer, MBA, Amanda Stoermer, MSW, and Heidi Miller, MD from the St. Louis Integrated Health Network for helping to foster the approval of this work through the Integrated Health Network Community Academic Partnership group. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of NIH. The research reported in this publication was supported by Grant Number 1P30DK092950 from the National Institute of Diabetes and Digestive and Kidney Diseases, the Washington University Institute for Clinical and Translational Sciences Grant UL1TR000448, subaward KL2TR000450, and Award Number KL2TR002346 from the National Center for Advancing Translational Sciences of NIH. This research was approved by the Washington University Human Research Protection Office under IRB# 201510005. The funding sources had no role in the study design; data collection; management, analysis, interpretation of the data; or manuscript preparation. CJH conceived of the study, provided clinical expertise, worked with MAO and MRK in data management to define the final population, conducted data analysis, and wrote the manuscript. MRK conducted all data management activities to refine the final population, developed the healthcare utilization and screening variables, and edited the manuscript. AMT conducted the geographic information systems analysis and edited the manuscript. BPC worked with CJH to develop the study design and data request plan and worked with collaborators to develop data use agreements. He provided mentorship in the use of electronic health record data and edited the manuscript. MAO provided administrative data analysis expertise, oversaw data management and analysis, and edited the manuscript. GAC made substantial contributions to study conception and design, data analysis and interpretation, and manuscript revision. CJH takes full responsibility for the content of this manuscript. All authors have read and approved the manuscript and agree to be accountable for their contributions and the accuracy and integrity of the work. Preliminary analyses for this manuscript were previously presented as a poster at the American Diabetes Association meeting on June 7?11, 2019 in San Francisco, California. CJH is currently funded on a career development award (K23HD096204) from the National Institutes of Child Health and Development. MAO and MRK are funded by the Center for Administrative Data Research, which is supported in part by the Washington University Institute of Clinical and Translational Sciences Grant UL1 TR002345 from the National Center for Advancing Translational Sciences and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality. CJH received an honorarium for speaking at the annual meeting of the Missouri Primary Care Association in October 2018 and October 2019. MAO receives grant funding from Pfizer, Sanofi Pasteur, and Merck and provides consultation services for Pfizer. BPC was previously employed by the Centene Corporation. No other financial disclosures were reported.
Funding Information:
The research reported in this publication was supported by Grant Number 1P30DK092950 from the National Institute of Diabetes and Digestive and Kidney Diseases, the Washington University Institute for Clinical and Translational Sciences Grant UL1TR000448, subaward KL2TR000450, and Award Number KL2TR002346 from the National Center for Advancing Translational Sciences of NIH. This research was approved by the Washington University Human Research Protection Office under IRB# 201510005.
Publisher Copyright:
© 2020 American Journal of Preventive Medicine
PY - 2021/2
Y1 - 2021/2
N2 - Introduction: Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion. Methods: Electronic health record and Medicaid claims data were linked to generate a retrospective cohort of 1,078 women with gestational diabetes receiving care in Federally Qualified Health Centers in Missouri from 2010 to 2015. In 2019–2020, data were analyzed to determine the factors associated with the receipt of recommended postpartum diabetes screening (fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c in specified timeframes) using a Cox proportional hazards model through 18 months of follow-up. Results: Median age in this predominantly urban population was 28 (IQR=24−33) years. Self-reported racial or ethnic minorities comprised more than half of the population. Only 9.7% of women were screened at 12 weeks, and 20.8% were screened at 18 months. Prenatal certified diabetes education (adjusted hazard ratio=1.74, 95% CI=1.22, 2.49) and access to public transportation (adjusted hazard ratio=1.70, 95% CI=1.13, 2.54) were associated with increased screening in a model adjusted for race/ethnicity, the total number of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific comorbidity index that incorporated age. Conclusions: This study underscores the importance of access to public transportation, prenatal diabetes education, and continued healthcare coverage for women on Medicaid to support the receipt of guideline-recommended follow-up care and improve health equity.
AB - Introduction: Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion. Methods: Electronic health record and Medicaid claims data were linked to generate a retrospective cohort of 1,078 women with gestational diabetes receiving care in Federally Qualified Health Centers in Missouri from 2010 to 2015. In 2019–2020, data were analyzed to determine the factors associated with the receipt of recommended postpartum diabetes screening (fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c in specified timeframes) using a Cox proportional hazards model through 18 months of follow-up. Results: Median age in this predominantly urban population was 28 (IQR=24−33) years. Self-reported racial or ethnic minorities comprised more than half of the population. Only 9.7% of women were screened at 12 weeks, and 20.8% were screened at 18 months. Prenatal certified diabetes education (adjusted hazard ratio=1.74, 95% CI=1.22, 2.49) and access to public transportation (adjusted hazard ratio=1.70, 95% CI=1.13, 2.54) were associated with increased screening in a model adjusted for race/ethnicity, the total number of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific comorbidity index that incorporated age. Conclusions: This study underscores the importance of access to public transportation, prenatal diabetes education, and continued healthcare coverage for women on Medicaid to support the receipt of guideline-recommended follow-up care and improve health equity.
UR - http://www.scopus.com/inward/record.url?scp=85097784265&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2020.08.028
DO - 10.1016/j.amepre.2020.08.028
M3 - Article
C2 - 33317895
AN - SCOPUS:85097784265
VL - 60
SP - 222
EP - 231
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
IS - 2
ER -