Impact of 17P usage on NICU admissions in a managed medicaid population--a five-year review.
OBJECTIVE
To evaluate whether providing 17 alpha-hydroxyprogesterone caproate (17P) to high-risk pregnant women who have a history of preterm delivery in a Medicaid managed care population reduces the rate of recurrent preterm delivery and neonatal intensive care unit (NICU) admissions.


METHODS
A 2004-2009 longitudinal review of birth outcomes in 193 singleton pregnant women with a history of spontaneous preterm delivery that were treated with 17P versus a control group.


METHODS
Intervention included offering 17P as a benefit to pregnant women who had a history of spontaneous preterm delivery and who were deemed to be appropriate candidates by their doctor. Members for this study were identified by claims review and obstetrical (OB) case managers in the health plans. A process of early identification, using a variety of data sources, was established along with an educational program aimed at physicians, their office staff, and plan members in order to increase 17P utilization in appropriate candidates.


RESULTS
Deliveries with a gestational age of less than 35 weeks decreased significantly from 41.67% in the control group to 26.42% in the 17P group when 17P was initiated by 28 weeks of gestation. The NICU admission rate decreased from 45% in the control group to 33.68% in this 17P group, and was nearly significant.


CONCLUSIONS
Offering 17P as a benefit does have a positive effect on reducing the rate of recurrent preterm delivery and rate of NICU admission in a managed Medicaid population. There was no decrease in effectiveness with delay in initiation of 17P as long as it was started by 28 weeks of gestation.
Mason
Mary V
MV
Centene Corp, St. Louis, Mo 63105, USA. mmason@centene.com
Poole-Yaeger
Amy
A
Krueger
Cathie R
CR
House
Kara M
KM
Lucas
Brad
B
D000077713:17 alpha-Hydroxyprogesterone Caproate; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006801:Humans; D006908:Hydroxyprogesterones / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007273:Injections, Intramuscular; D008137:Longitudinal Studies; D008329:Managed Care Programs; D008484:Medicaid; D015337:Multicenter Studies as Topic; D054582:National Institute of Child Health and Human Development (U.S.); D010349:Patient Compliance; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration
D006908:Hydroxyprogesterones; D000077713:17 alpha-Hydroxyprogesterone Caproate