Graduate Thesis Or Dissertation
 

Effect of Oregon’s Coordinated Care Organizations on Healthcare Utilization and Maternal and Neonatal Outcomes Among Low-income Women with Chronic Mental-Physical Comorbidities

Pubblico Deposited

Contenuto scaricabile

Scarica il pdf
https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/76537862f

Descriptions

Attribute NameValues
Creator
Abstract
  • Background: The number of people diagnosed with chronic physical conditions is increasing in the United States. Chronic mental illnesses are also common in the country. Low-income women and those on Medicaid bear a disproportionate burden of chronic conditions and these conditions significantly contribute to obstetric morbidity. Prioritizing preventive measures and effective management strategies is, therefore, critical to address the country's growing burden of chronic mental-physical comorbidities (MPCs), particularly among vulnerable populations. This study examined the effect of the Coordinated Care Organizations (CCOs) model on healthcare utilization during pregnancy and maternal and neonatal health outcomes among Oregon women with chronic MPCs who were enrolled in Medicaid. Method: I analyzed a uniquely linked data set that came from Oregon Medicaid eligibility and claims, birth certificate, and hospital discharge data for women aged 15-44 with live births from 2008 through 2016. The outcome binary variables used to examine healthcare utilization were early prenatal care initiation, adequacy of prenatal care, preventable hospital admissions, all-cause ED visits, and preventable ED visits during pregnancy. The outcome binary variables used to investigate maternal and neonatal health outcomes were maternal morbidities, low birth weight, small for gestational age, abnormal conditions, and low five-minute Apgar score. The independent variables were indicators of post-CCO enrollment and Medicaid CCO enrollment greater than 80% during pregnancy. I analyzed data using the logistic and fixed-effects difference-in-differences regression models. Models were adjusted for maternal and neonatal characteristics and time trends. Results: Following the implementation of the CCO model, women with MPCs enrolled in CCOs experienced an average increase of 0.055 percentage points (p<0.001) in their probability of timely initiation of prenatal care utilization, an average increase of 0.042 percentage points (p<0.01) in their probability of adequate prenatal care utilization, and an average decrease of 0.036 percentage points (p<0.001) in the probability of preventable ED visits. Following the implementation of CCOs, neonates of women with MPCs experienced increases in the probability of low birth weight and abnormal conditions and decreases in the probability of small for gestational age and low five-minute Apgar score although these changes were not statistically significant. Conclusion: While this study confirms the effectiveness of Oregon's Coordinated Care Organization model in advancing healthcare utilization, it also sheds light on the shortcomings of CCOs in enhancing health outcomes for women with chronic MPCs and their newborns. Acknowledging the broader spectrum of factors that impact health outcomes, including socioeconomic characteristics and social determinants of health, it becomes imperative to incorporate these considerations when developing interventions aimed at improving maternal and neonatal outcomes. Implications: The findings of this study significantly advanced our understanding of the effects of the ACO models on healthcare utilization and health outcomes among women with chronic MPCs and their newborns. Furthermore, this study added to the body of literature that can be used to inform and guide ongoing healthcare system innovation efforts.
License
Resource Type
Date Issued
Degree Level
Degree Name
Degree Field
Degree Grantor
Commencement Year
Advisor
Committee Member
Academic Affiliation
Dichiarazione dei diritti
Publisher
Peer Reviewed
Language
File Format

Le relazioni

Parents:

This work has no parents.

In Collection:

Elementi

Thumbnail Titolo Data caricata Visibilità Azioni
file details MasoumiradMandana2023.pdf 2023-09-05 Pubblico Scaricare