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Arden Handler

Publications and source records attributed to Arden Handler.

13 recordsLinked to original sources
PubMed2006

Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?

OBJECTIVES: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. METHODS: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. RESULTS: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. CONCLUSIONS: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.

Adult↗
PubMed2006

Validity of self-reported use of assisted reproductive technology treatment among women participating in the Pregnancy Risk Assessment Monitoring System in five states, 2000.

OBJECTIVES: To assess the validity of a question on assisted reproductive technology (ART) incorporated into the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2000. While the intent of the question is to ascertain whether the index infant was conceived using ART, the phrasing was ambiguous for women who had used ART while trying to conceive the index infant but became pregnant after discontinuing treatment. METHODS: We compared weighted PRAMS estimates from five states that incorporated the ART question in 2000 with data from the U.S. ART Surveillance System (ART-SS) maintained by the Centers for Disease Control and Prevention (CDC). U.S. medical practices are mandated to report data for every ART procedure to CDC annually; thus, the ART-SS is highly specific and complete. RESULTS: ART use was reported for 156 of the PRAMS births in our study population, representing 4,571 (95% Confidence Limit, 3,452-5,690) births from the total birth cohort in the five states of interest in 2000. For the same maternal residency states and year, 1,768 births were reported to the ART-SS. Thus, we calculate that PRAMS overestimated ART use by 2,803 births. PRAMS estimated 2.59 times as many ART births as reported to the ART-SS. While for singletons, a large excess in estimated births from PRAMS was observed (ratio=3.50), there was little difference between the PRAMS estimates and ART-SS for twin and triplet births. CONCLUSION: These findings suggest women responding to PRAMS may be reporting past ART use in addition to current. The findings by plurality support this hypothesis.

Birth Weight↗
PubMed2006

The pre-pregnancy insurance status of public aid recipients in the aftermath of welfare reform: women in the Medicaid Gap.

The passage of welfare reform in 1996 led to sweeping changes in both welfare and Medicaid policy. This study examines the pre-pregnancy Medicaid coverage of women on public aid who had Medicaid payment for delivery in the time periods before and after welfare reform. Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to examine changes in the prevalence of being in the Medicaid Gap (i.e., having no pre-pregnancy Medicaid coverage despite having Medicaid payment for delivery) in eight states between 1996 (n=302) and 1998-2000 (n=364). Of this population, 16.1% of women were in the Medicaid Gap in 1996, compared with 36.5% in 1998-2000. The overall adjusted relationship between time period and being in the Medicaid Gap was 4.5 (95% CI 2.1-9.6). This analysis suggests that in the period after welfare reform, there was an increase in the prevalence of very low-income women who, despite having their delivery paid for by Medicaid, did not have pre-pregnancy Medicaid coverage. Lack of Medicaid coverage regardless of pregnancy, particularly among women who historically have had such coverage and who are at higher risk of adverse pregnancy outcomes, has important implications for progress toward Healthy People 2010 objectives in prenatal care initiation and utilization, low birth weight, and other pregnancy outcomes.

Adult↗
PubMed2005

Welfare reform, insurance coverage pre-pregnancy, and timely enrollment: an eight-state study.

Implementation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) broke the automatic linkage between Medicaid eligibility/enrollment and welfare cash assistance for women eligible at welfare income levels. This study used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for the period 1996-1999 to examine insurance coverage of these and other pregnant women pre- and post-PRWORA. Controlling for individual characteristics and economic growth, the relative odds of having private insurance did not change while the odds of being Medicaid enrolled versus uninsured pre-pregnancy declined for welfare-eligible women post-PRWORA. The absolute effect was a decline of 7.9 percentage points in the probability of welfare-eligible women being insured. While these results apply to the early years of welfare reform, it is still likely that states can improve Medicaid outreach and enrollment of women eligible prior to pregnancy.

Adolescent↗
PubMed2004

A new method for classifying patterns of prenatal care utilization using cluster analysis.

OBJECTIVES: The objectives of this study were: to 1) define patterns of prenatal care utilization using cluster analysis, 2) describe two alternative cluster solutions and compare these groupings to the Adequacy of Prenatal Care Utilization Index (APNCU), 3) compare the cluster solutions and the APNCU with respect to maternal age and prematurity, and 4) discuss advantages and disadvantages of using cluster analysis to study prenatal care. METHODS: The study sample included 3544 women in the 1988 National Maternal and Infant Health Survey for whom complete prenatal care visit data were available. Clustering was carried out in two stages, first employing nearest centroid sorting (the k means method), a nonhierarchical approach, and then using Ward's Minimum Variance Method, a hierarchical clustering technique. RESULTS: Patterns of prenatal care defined by cluster analysis varied by timing of the first visit, total number of visits, and the rate of accumulation of visits, but this variation was different compared to that seen for the APNCU. While the cluster solutions and the APNCU identified a similar normative pattern of care, other patterns identified were quite different. In particular, the six-cluster solution differentiated among women who entered care at similar times, but accumulated visits at differing rates and experienced differing rates of preterm delivery. CONCLUSION: Cluster analysis is a new tool for studying prenatal care. Further studies are needed to refine the method and test whether the alternative perspective it provides will lead to new findings concerning the relationship of prenatal care and birth outcomes.

Birth Certificates↗
PubMed2004

FIMR and other mortality reviews as public health tools for strengthening maternal and child health systems in communities: where do we need to go next?

This article examines FIMR in relationship to two other maternal and child health mortality reviews--child fatality review (CFR) and maternal mortality review (MMR), and explores how their approaches to reviewing deaths can complement one another. Identifying opportunities for collaboration among these case review methodologies may lead to greater efficiencies at the local and state levels and strengthen the case review approach as a public health tool for improving maternal and child health outcomes. To enable comparative analysis, a table was constructed that identifies the purpose, structure, and process features of each case review approach. This was followed by an examination of two possible ways to improve maternal and child mortality review processes in states: 1) better coordination; and 2) improving each individual process through adapting and adopting promising practices from the others. A discussion is also provided of the state Title V role in facilitating both the coordination of reviews and the process of sharing best practices. Given the similarities that exist among the three MCH mortality reviews, it is important to view each review as one component of a larger system of maternal and child health death reviews. Implementing widely the recommendations generated by these reviews may increase the likelihood of improvements in services and systems on behalf of women and children.

Child Health Services↗
PubMed2004

Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination.

OBJECTIVES: We determined whether African American women's lifetime exposure to interpersonal racial discrimination is associated with pregnancy outcomes. METHODS: We performed a case-control study among 104 African American women who delivered very low birthweight (<1500 g) preterm (<37 weeks) infants and 208 African American women who delivered non-low-birthweight (>2500 g) term infants in Chicago, Ill. RESULTS: The unadjusted and adjusted odds ratio of very low birthweight infants for maternal lifetime exposure to interpersonal racism in 3 or more domains equaled 3.2 (95% confidence intervals=1.5, 6.6) and 2.6 (1.2, 5.3), respectively. This association tended to persist across maternal sociodemographic, biomedical, and behavioral characteristics. CONCLUSIONS: The lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery.

Adult↗
PubMed2003

Satisfaction and use of prenatal care: their relationship among African-American women in a large managed care organization.

BACKGROUND: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States-a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. METHODS: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. RESULTS: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. CONCLUSIONS: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted.

Adolescent↗
PubMed2002

Assessing capacity and measuring performance in maternal and child health.

OBJECTIVES: To understand the similarities, differences, and relationships between three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies. METHODS: Three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies, the Title V MCH Block Grant Performance and Outcome Measures (Title V "24"), CAST-5, and the National Public Health Performance Standards Program (NPHPSP) were compared using two metrics, a conceptual model of the public health system, and a set of attributes related to the use of the instruments. RESULTS: Both CAST-5 and the NPHPSP are focused on the capacity and key processes (10 Essential Public Health Services) of the public health system, although CAST-5 is intended for capacity assessment and the NPHPSP is intended for performance measurement. The Title V "24" tool is also intended for performance measurement; however, its focus is on the outputs and outcomes of the health system. The Title V "24" tool is the only one of the three that is mandatory, and the only one whose results at the current time can be used to compare across entities. In addition, both the Title V "24" and the NPHPSP include explicit standards, while CAST-5 does not specify explicit standards against which to compare findings. CONCLUSIONS: While there are various tools available to MCH practitioners for capacity assessment and performance measurement, knowing how the tools relate to each other, and their defining characteristics, should lead to more effective and productive use.

Child↗
PubMedDate not supplied

Prenatal care characteristics and African-American women's satisfaction with care in a managed care organization.

This study examined the characteristics of prenatal care affecting women's satisfaction for two groups of African-American women, those with Medicaid insurance and those with commercial insurance, who sought care through a large managed care organization in the Midwest. African-American pregnant managed care patients (n = 400), regardless of payer status, were more satisfied when their providers spent more time with them and when their providers engaged them by explaining procedures, asking them questions, and answering their questions. Satisfaction was also higher for both Medicaid (n = 125) and commercially insured women (n = 275) when the waiting room was clean and comfortable. The care characteristics most important to an African-American woman's satisfaction with prenatal care do not appear to be dependent on her payer status, nor do they seem to be particularly dependent on the financial arrangements of her care provider. While improvements in health care delivery tend to focus on increasing technical proficiency to improve pregnant women's satisfaction with care, prenatal care providers should focus on improvements in patient-provider communication, as well as features of the prenatal care setting (e.g., cleanliness, waiting times, availability of ancillary services).

Adult↗
PubMedDate not supplied

Transitions in insurance coverage from before pregnancy through delivery in nine states, 1996-1999.

Efforts to extend coverage to pregnant women, along with an expanding economy, did not prevent increases in the uninsured in the latter 1990s. Welfare reform may have led to declining Medicaid enrollments and caseloads. Data representative of live births in nine states show that in some states more than one-third of all pregnant women and almost two-thirds of low-income pregnant women lacked insurance before their pregnancy in 1996 and 1999. More than one-third of all pregnant women made some change in coverage by the time they delivered their baby. Among low-income women, the largest change was from uninsured status before pregnancy to Medicaid at delivery.

Alaska↗