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 Given the vulnerability of women and infants toadverse peripartum conditions, federal programsprovide access to prenatal...
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Characterizing Emergency Department Utilization By A Population-based Cohort of Insured Pregnant Women_ Karin Rhodes_ 5_7_13


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Characterizing Emergency Department Utilization By A Population-based Cohort of Insured Pregnant Women_ Karin Rhodes_ 5_7_13

  1. 1.  Given the vulnerability of women and infants toadverse peripartum conditions, federal programsprovide access to prenatal care and socialservices, but few studies have examined EDutilization by this populationBackgroundTable 2: Adjusted Logistic Regression* (n=658)ED Use(n=218)No ED Use(n=440)OR 95% CIPsychosocial RiskPostpartum depression 40 20.1%** 29 6.8% 2.9 1.7 – 5.0Prenatal Smoker 61 28.1%** 36 8.2% 3.0 1.8 – 4.9Hx Alcohol Problem 6 6.1%** 3 1.5% 3.2 0.7 – 14.5Hx Drug Problem 7 7.1%** 4 2.0% 2.5 0.6 – 9.4History of abuse 39 21.9%** 55 15.2% 1.3 0.8 – 2.1Unstable Housing 34 16.4%** 29 7.2% 2.0 1.2 – 3.6Birth OutcomesLow Birth Weight 15 6.9% 16 3.7% 1.4 0.7 – 3.0Prematurity 20 9.2%** 21 4.8% 1.9 0.9 – 3.7Primary Care UtilizationDelayed entry into prenatal care 59 27.4%** 59 13.7% 1.6 1.0 – 2.5Did not attend postpartum visit 24 12.2%** 20 4.7% 2.1 1.1 – 4.0*Adjusted for adolescence, marital status, race and medical insurance **p<.05 Pearson Chi-Square Secondary analysis of data from a Midwestern county-wide postpartum depression study County residents giving birth Feb-May 2009 weresystematically recruited from postpartum hospital floor. 670 (74%) of eligible women were enrolled. 658 Final Sample (12 withdrew from study) Trained research assistants (RAs) conducted phoneinterviews at 2 months postpartum, collectinginformation about psychosocial risk . 621 (94%) completed the survey. RAs, monitored for intercoder reliability, also collecteddemographics & pregnancy outcomes. ED-visit datasets were produced from hospitaladministrative records. The peripartum period was defined as 8 weeks gestationto 4 months postpartum Logistic regression, adjusted for demographic factors,was used to identify the association betweenpsychosocial risk, birth outcomes, primary careutilization and ED use.Methods Among participants, 218 (33%) used the ED atleast once and 108 (16%) had more than one EDvisit during their peripartum period. 49% of ED visits generated by this group were fornon-obstetric illness, 38% for obstetric-postpartumreasons, 10% for injury and 3% forsubstance/mental health concerns. ED users were significantly more likely to beteenagers (14.2% v 6.4%; p=0.001 ), single (58.3%v 28.7%; p<0.001 ), black (29.4% v 10.7%;p<0.001 ), and Medicaid-insured (47.7% v 22.0%;p<0.001 ). ED users were significantly more likely to have thefollowing psychosocial and health risks:Postpartum depression, prenatal smoking, drug oralcohol problem, a history of abuse, insecurehousing, obese body mass index (32.4% v 19.9%,p=.002), inadequate prenatal weight gain (24.7% v13.7%, p=.002), late entry into prenatal care, andmissed postpartum checkup visit.Results Adjusting for demographic factors, ED users weremore likely to screen positive for postpartumdepression, OR=2.9 (1.7-5.0), to smoke prenatallyOR=3.0 (1.8-4.9), to have unstable housing, OR2.0 (1.2-3.5), delayed onset into prenatal care, OR1.6 (1.0-2.5) and fail to attend their postpartumvisit, OR=2.1(1.1-4.0).Results Cont.Limitations/Policy Implications Among a fully insured sample of pregnantwomen, an ED visit was a marker for poorperinatal outcomes and inadequate primary careConclusions2009 CountyPopulation(N=2,674)Study Sample(658)p-valueAgeAdolescent (<20)Not Adolescent (20+)9.6%90.4%9.0%91.0%0.6379Maternal RaceWhiteBlackOther76.3%19.5%4.2%78.3%16.9%4.9%0.1277Marital StatusMarriedSingle58.5%41.5%61.5%38.5%0.1609Insurance StatusPrivateMedicaidNo insurance51.8%47.6%0.6%67.3%30.5%2.1%<0.0001Prenatal Care (Kessner)AdequateIntermediateInadequate65.9%26.6%7.1%72.3%22.9%4.8%0.0338Prenatal BMIUnderweightHealthy weightOverweightObese3.6%45.2%25.3%25.9%2.4%47.9%25.7%24.0%0.1261BirthweightAdequate (2500+ grams)LBW (1501-2499 grams)VLBW (<1501 grams92.8%6.0%1.1%95.3%4.0%0.8%0.0216Prematurity<37 wks gestation37-52 wks gestation8.4%91.6%6.2%93.8%0.0619 These findings indicate a need for integratedpsychosocial interventions in the perinatalperiod among pregnant ED users And an opportunity to link to primary careCharacterizing Emergency Department UtilizationBy A Population-based Cohort of Insured Pregnant WomenKarin V. Rhodes, MD, MS¹; Catherine Kothari², Shama Tareen³, Michael Lipman³¹University of Pennsylvania SOM, Dept of Emergency Medicine ²Western Michigan University SOM, Dept of Emergency Medicine,³Western Michigan University SOM Dept of Psychiatry To characterize ED utilization and differences inrisks and outcomes between pregnant womenwho use vs. do not use the ED during theirperipartum period.ObjectiveTable 1: Study Sample Demographics (n=658)Figure 1: Edinburgh Postpartum Depression Scores