title: Predictors of prenatal and postpartum care adequacy in a medicaid managed care population.
abstract: OBJECTIVE
  To examine factors affecting prenatal and postpartum care for an insured, but vulnerable, population.
  
  
  METHODS
  Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial logistic function with individual and neighborhood characteristics, provider type, and health plan as explanatory variables.
  
  
  RESULTS
  In our sample, 85% of women initiated care in the first trimester, but only 62% met the goal of receiving more than 80% of the recommended number of prenatal visits. Just 60% had a timely postpartum care visit. Having a diagnosis of substance abuse or dependence reduced the odds of meeting all measures. Women with disabilities were less likely to attain two of the three measures of adequate care, as were women with other children in the household. Women who enrolled in Medicaid in the first trimester were more likely to receive the recommended number of prenatal visits than those who were enrolled before pregnancy.
  
  
  CONCLUSIONS
  Given the importance of prenatal and postpartum care for maternal and child health and the recent national declining trend in timely care, initiatives to improve rates of timely and adequate care are crucial and must include components tailored toward particularly vulnerable subpopulations.
authors.affiliation: Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, Massachusetts, USA. Sharada.Weir@umassmed.edu
authors.forename: Sharada
authors.initials: S
authors.lastname: Weir
authors.forename: Heather E
authors.initials: HE
authors.lastname: Posner
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
authors.forename: Georgianna
authors.initials: G
authors.lastname: Willis
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Baxter
authors.forename: Robin E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D016015:Logistic Models; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008404:Massachusetts; D008484:Medicaid; D008875:Middle Aged; D011181:Postnatal Care / Q000191:economics / Q000592:standards*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics; D011295:Prenatal Care / Q000191:economics / Q000592:standards*; D019966:Substance-Related Disorders; D014481:United States; D055815:Young Adult