Comparing Postpartum Care Utilization from Medicaid Claims and the Pregnancy Risk Assessment Monitoring System in...

Area of Science:

• Public Health
• Health Services Research
• Maternal Health

Background:

• Postpartum care utilization is crucial for maternal health outcomes.
• Discrepancies exist between administrative claims data and self-reported survey data for healthcare utilization.
• Wisconsin-Medicaid claims and PRAMS surveys offer distinct perspectives on postpartum care access.

Purpose of the Study:

• To compare postpartum care utilization data between Wisconsin-Medicaid claims and PRAMS surveys.
• To investigate the reasons for incongruence between these two data sources.
• To enhance understanding of postpartum care measurement in Medicaid populations.

Main Methods:

• Linked Wisconsin Medicaid claims and PRAMS survey data from 2011-2015.
• Utilized three definitions of postpartum care from Medicaid claims.
• Assessed concordance using Cohen's Kappa and examined discrepancies for women reporting checkups in PRAMS without corresponding claims.

Main Results:

• 86.6% of women had Medicaid claims for postpartum visits within 12 weeks; 90.5% self-reported checkups on PRAMS.
• Overall agreement (Kappa = 0.015) was slight, varying by Medicaid claims definition.
• Discrepancies highlighted potential underestimation or misclassification of postpartum care in claims data.

Conclusions:

• Slight agreement exists between Medicaid claims and PRAMS data for postpartum care utilization.
• Most women utilized postpartum care within the first 12 weeks postpartum, as indicated by Medicaid claims.
• Bundled service codes in Medicaid claims obscure the precise timing and nature of postpartum visits.