title: Influence of provider characteristics and insurance status on maternal serum alpha-fetoprotein screening.
abstract: BACKGROUND
  The maternal serum alpha-fetoprotein test (MSAFP) was developed to screen for neural tube defects. Little is known about the adoption of the MSAFP test. This study examines the effect of provider specialty and geographic location and patient insurance status on MSAFP test use in Washington State.
  
  
  METHODS
  We conducted a retrospective cohort study of MSAFP use in low-risk obstetric patients of five provider groups. MSAFP use was examined for Medicaid and privately insured patients, as well as for the patients of the five provider types.
  
  
  RESULTS
  Patients of urban and rural obstetrician-gynecologists were most likely to have MSAFP testing (80.4 percent and 77.0 percent, respectively); patients of urban certified nurse midwives and rural family physicians were least likely to have MSAFP testing (64.2 percent and 62.2 percent, respectively). Patients of certified nurse midwives were more likely to decline MSAFP testing when offered (26.1 percent). Medicaid-insured women were significantly less likely to have MSAFP testing than privately insured women (60.5 percent versus 79.1 percent, P < or = 0.05).
  
  
  CONCLUSIONS
  Providers and patients did not uniformly use MSAFP screening. Efforts should be made to ensure that all patients are adequately informed of screening tests for neural tube defects.
authors.affiliation: Duke University Department of Family and Community Medicine, Chapel Hill, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Jenkins-Woelk
authors.forename: L M
authors.initials: LM
authors.lastname: Baldwin
authors.forename: T R
authors.initials: TR
authors.lastname: Raine
authors.forename: L G
authors.initials: LG
authors.lastname: Hart
authors.forename: M A
authors.initials: MA
authors.lastname: Fordyce
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
mesh_terms: D005260:Female; D006801:Humans; D007357:Insurance, Physician Services; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014861:Washington; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins