目的:为了检查全面,多年(2015-2020)在特拉华州对产后医疗补助患者的避孕开始进行全州范围内的避孕干预。该计划旨在增加获得所有避孕药具的机会,包括长效可逆避孕药(LARC)。该计划包括专门针对产后患者的干预措施(医疗补助支付改革和基于医院的即时产后(IPP)LARC培训)和门诊设置的干预措施(提供者培训和操作支持)。
方法:我们使用了2012年至2019年之间的医疗补助索赔数据,来自特拉华州和马里兰州(比较状态),在15-44岁的患者中,确定分娩和产后60天的避孕方法,这些患者被纳入全面福利资格类别。
方法:使用差异差异,我们评估了LARC的变化,输卵管结扎,和短效方法(口服避孕药,可注射,补丁/环)。在分娩后60天和产后立即评估LARC率。其他方法仅在60天评估。对早期采用的高容量医院(大约一半的医疗补助资助分娩)和该州所有其他后期采用的医院分别进行了分析。
方法:数据来自行政索赔。
结果:该计划在分娩后60天增加了产后LARC插入率,在早期收养医院增加了11.7个百分点(95%CI:10.7,12.8),在后期收养医院增加了6.9个百分点(95%CI:4.8,5.9)。IPP与门诊LARC的增加推动了这种变化,但我们没有发现IPP挤出门诊LARC服务的证据.我们观察到短效方法的减少,建议方法之间的替换,但采用任何方法的患者比例在早期采用医院增加(5.2个百分点;95%CI:3.5,6.9),在后期采用医院没有统计学差异.
结论:IPPLARC的直接报销,结合提供者培训,对接受医疗补助的产后女性LARC索赔的比例产生了有意义的影响。
OBJECTIVE: To examine the effects of a comprehensive, multiyear (2015-2020) statewide contraceptive access intervention in
Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long-acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital-based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports).
METHODS: We used Medicaid claims data between 2012 and 2019, from
Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60 days postpartum among patients aged 15-44 years who were covered in a full-benefit eligibility category.
METHODS: Using difference-in-differences, we assessed changes in LARC, tubal ligation, and short-acting methods (oral contraceptive, injectable, patch/ring). LARC rates were assessed at 60 days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60 days. Analyses were conducted separately for an early-adopting high-capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later-adopting hospitals in the state.
METHODS: Data were extracted from administrative claims.
RESULTS: The program increased postpartum LARC insertions by 60 days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early-adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later-adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded-out outpatient LARC services. We observed decreases in short-acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early-adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later-adopting hospitals.
CONCLUSIONS: Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid-enrolled postpartum women with LARC claims.