Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Kane DJ [original query] |
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Need for Contraceptive Services Among Women of Reproductive Age - 45 Jurisdictions, United States, 2017-2019
Zapata LB , Pazol K , Curtis KM , Kane DJ , Jatlaoui TC , Folger SG , Okoroh EM , Cox S , Whiteman MK . MMWR Morb Mortal Wkly Rep 2021 70 (25) 910-915 Ensuring access to contraceptive services is an important strategy for preventing unintended pregnancies, which account for nearly one half of all U.S. pregnancies (1) and are associated with adverse maternal and infant health outcomes (2). Equitable, person-centered contraceptive access is also important to ensure reproductive autonomy (3). Behavioral Risk Factor Surveillance System (BRFSS) data collected during 2017-2019 were used to estimate the proportion of women aged 18-49 years who were at risk for unintended pregnancy* and had ongoing or potential need for contraceptive services.(†) During 2017-2019, in the 45 jurisdictions(§) from which data were collected, 76.2% of women aged 18-49 years were considered to be at risk for unintended pregnancy, ranging from 67.0% (Alaska) to 84.6% (Georgia); 60.7% of women had ongoing or potential need for contraceptive services, ranging from 45.3% (Puerto Rico) to 73.7% (New York). For all jurisdictions combined, the proportion of women who were at risk for unintended pregnancy and had ongoing or potential need for contraceptive services varied significantly by age group, race/ethnicity, and urban-rural status. Among women with ongoing or potential need for contraceptive services, 15.2% used a long-acting reversible method (intrauterine device or contraceptive implant), 25.0% used a short-acting reversible method (injectable, pill, transdermal patch, or vaginal ring), and 29.5% used a barrier or other reversible method (diaphragm, condom, withdrawal, cervical cap, sponge, spermicide, fertility-awareness-based method, or emergency contraception). In addition, 30.3% of women with ongoing or potential need were not using any method of contraception. Data in this report can be used to help guide jurisdictional planning to deliver contraceptive services, reduce unintended pregnancies, ensure that the contraceptive needs of women and their partners are met, and evaluate efforts to increase access to contraception. |
Policy change is not enough: Engaging provider champions on immediate postpartum contraception
Okoroh EM , Kane DJ , Gee RE , Kieltyka L , Frederiksen BN , Baca KM , Rankin KM , Goodman DA , Kroelinger CD , Barfield WD . Am J Obstet Gynecol 2018 218 (6) 590 e1-590 e7 Rates of short interval pregnancies resulting in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception (LARC) methods have annual failure rates of less than 1% compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to LARCs in the immediate postpartum period, several State Medicaid programs, including those in Iowa (IA) and Louisiana (LA), recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum LARC insertion. We used a mixed-methods approach, to analyze 2013-2015 linked Medicaid and vital records data from both IA and LA, to describe trends in immediate postpartum LARC provision one year prior to and following the Medicaid reimbursement policy change. We also used data from key informant interviews with State program staff to understand how provider champions affected policy uptake. We found that the monthly average for the number of insertions in IA increased from 4.6 per month prior to the policy to 6.6 per month post policy, and in LA, the average increased from 2.6 per month prior to the policy to 45.2 per month. In both states, the majority of insertions occurred at one academic/teaching hospital. In LA, the additional increase may be due to the engagement of a provider champion who worked at both the state and facility level. Recruiting, training, engaging, and supporting provider champions, as facilitators, with influence at state and facility levels, is an important component of a multipart strategy for increasing successful implementation of State-level Medicaid payment reform policies that allow reimbursement for immediate postpartum LARC insertions. |
Evaluating Iowa severe maternal morbidity trends and maternal risk factors: 2009-2014
Frederiksen BN , Lillehoj CJ , Kane DJ , Goodman D , Rankin K . Matern Child Health J 2017 21 (9) 1834-1844 Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009-2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa's 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25-34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus. |
Use of clinical performance measures for contraceptive care in Iowa, 2013
Frederiksen BN , Kane DJ , Rivera M , Wheeler D , Gavin L . Contraception 2017 96 (3) 158-165 OBJECTIVES: To assess feasibility of calculating clinical performance measures for contraceptive care for National Quality Forum submission: the percentage of women aged 15-44 provided: 1) a most or moderately effective contraceptive method (MME), and 2) a long-acting reversible contraceptive (LARC) method. METHODS: We used 2013 Iowa Department of Public Health (IDPH) Title X and Iowa Medicaid data. We stratified Title X data by age and Medicaid data by age and benefit type (family planning waiver (FPW) vs. general Medicaid), and examined variation by residence, public health region, and health plan based on program interest. FINDINGS: Among women attending IDPH Title X clinics in 2013 (N=11,584), 86% of women ages 15-20years and 83% of women ages 21-44years were provided MME; 20% of women ages 15-20years and 20% of women ages 21-44years were provided LARC. Estimates varied across Title X sub-recipient agencies, which receive federal funds from IDPH. Among Medicaid FPW clients (N=30,013), 79% of women ages 15-20years and 73% of women ages 21-44years were provided MME; 12% of women ages 15-20years and 11% of women ages 21-44years were provided LARC. Among general Medicaid clients (N=14,737), 40% of women ages 15-20years and 28% of women ages 21-44years were provided MME; 5% of women ages 15-20years and 5% of women ages 21-44years were provided LARC. CONCLUSION: A high percentage of IDPH Title X and FPW clients were provided a MME method. No reporting entity had a LARC percentage less than 1-2%. IMPLICATIONS: Measure calculation using Title X and Medicaid data is feasible and can potentially be used to identify ways to increase access to contraceptive methods. |
Factors associated with receiving treatment for dental decay among Medicaid-enrolled children younger than 12 years of age in Iowa, 2010
Zilversmit L , Kane DJ , Rochat R , Rodgers T , Russell B . J Public Health Dent 2014 75 (1) 17-23 OBJECTIVES: The Iowa Department of Public Health I-Smile program provides dental screening and care coordination to over 23,000 low-income and Medicaid-enrolled children per year. The purposes of this study were to evaluate I-Smile program effectiveness to ensure that Medicaid-enrolled children obtained dental treatment after having been screened and to determine the factors associated with failure to receive dental care after screening through the I-Smile program. METHODS: Based on I-Smile program priorities, we limited our sample to children younger than 12 years of age who screened positive for decay and who linked to a paid Medicaid claim for dental treatment (n = 1,816). We conducted bivariate analyses to examine associations between children's characteristics who screened positive for decay and received treatment within 6 months of their initial screening. We also performed multivariate logistic regression to assess the association of sociodemographic characteristics with receipt of treatment among children who screened positive for decay. RESULTS: Eleven percent of children screened positive for decay. Nearly 24 percent of children with decay received treatment based on a Medicaid-paid claim. Being 5 years or older [adjusted odds ratio (aOR): 1.48, confidence interval (CI): 1.17, 1.88] and not having a dental home (aOR: 1.90, CI: 1.41, 2.58) were associated with higher odds of not receiving dental treatment. CONCLUSIONS: Children 5 years and older and without a dental home were less likely to obtain dental treatment. Opportunities exist for the I-Smile program to increase the numbers of at-risk children with dental homes and who obtain dental care after screening. |
Ascertainment of medicaid payment for delivery on the Iowa birth certificate: is accuracy sufficient for timely policy and program relevant analysis?
Kane DJ , Sappenfield WM . Matern Child Health J 2014 18 (4) 970-7 The Iowa Department of Public Health annually links Medicaid claims data to the birth certificate. Because the latest version of the birth certificate provides more timely and less costly information on delivery payment source, we were interested in assessing the validity and reliability of the birth certificate payment source compared to Medicaid paid claims. We linked Medicaid paid claims to birth certificates for calendar years 2007-2009 (n = 120,626). We measured reliability by Kappa statistic and validity by sensitivity, specificity, predictive value positive and negative. We examined reliability and validity overall and by maternal characteristics (e.g. age, race, ethnicity, education). The Kappa statistic for the birth certificate payment source indicated substantial agreement (0.78; 95 % CL 0.78-0.79). Sensitivity and specificity were also high, 86.3 % (95 % CL 86.0-86 6 %) and 91.9 % (95 % CL 91.7-92.1 %), respectively. The predictive value positive was 87.0 %. The predictive value negative was 91.4 %. Kappa and specificity were lower among women of racial and ethnic minorities, women younger than age 24, and women with less education. The overall Kappa, sensitivity and specificity generally suggest the birth certificate payment source is as valid and reliable as the linked data source. The birth certificate payment source is less valid and reliable for women of racial and ethnic minorities, women younger than age 24, and those with less education. Consequently caution should be exercised when using the birth certificate payment source for monitoring service use by the Medicaid population within specific population subgroups. |
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