Drivers of Postpartum Readmissions with and without Severe Maternal Morbidity, Oregon All Payer All Claims 2012-2018
Institution
OHSU
Program/Major
Epidemiology
Degree
PhD
Presentation Type
Presentation
Start Date
4-8-2021 9:50 AM
End Date
4-8-2021 10:01 AM
Persistent Identifier
https://archives.pdx.edu/ds/psu/35584
Keywords
Maternal Health, SMM, Postpartum
Abstract
Background: Given the rise in maternal mortality in the US, substantial research and health policy focus have been given to “near misses” of maternal mortality – often classified as severe maternal morbidity (SMM). However, readmissions without evidence of SMM are also common, and are significant markers of maternal morbidity in ways that are not yet fully understood. We assessed which demographic, clinical, and system-level factors are associated with postpartum readmission without evidence of SMM and if they differ from risk factors for postpartum readmissions with evidence of SMM.
Methods: We conducted a retrospective cohort study using All Payer All Claims Data (APAC) among persons age 15-44 with a hospital delivery in Oregon from 2012-2017. We estimated the associations between demographic (i.e. age and rurality), clinical (i.e. delivery route, comorbidities), and system-level factors (i.e. insurance type, hospital rurality) and postpartum readmissions up to 12 months from delivery discharge. We created two outcome measures – postpartum readmissions with evidence of SMM and without evidence of SMM. For each factor, we built multivariate models to estimate cumulative incidence ratios, controlling for confounders identified using directed acyclic graphs.
Results: The overall postpartum readmission rate within 12 months of delivery discharge was 1.8%. Of these, 84% had no evidence of SMM. Age was not associated with the risk of SMM-related readmissions. In contrast, people under the age of 24 were 44% more likely to be readmitted without evidence of SMM compared to those aged 25-29 (RR: 1.44; 95% CI: 1.32 – 1.57). Medicaid insurance at delivery was strongly associated with readmissions with SMM (RR: 12.87; 95% CI: 8.76, 18.92) and without SMM (RR: 9.85; 95% CI: 8.46, 11.46).
Conclusion: Drivers of postpartum readmissions differ depending on the presence of SMM. Our research shows that policies aimed at reducing postpartum morbidity delivery must address system level factors that lead to maternal health inequities.
Drivers of Postpartum Readmissions with and without Severe Maternal Morbidity, Oregon All Payer All Claims 2012-2018
Background: Given the rise in maternal mortality in the US, substantial research and health policy focus have been given to “near misses” of maternal mortality – often classified as severe maternal morbidity (SMM). However, readmissions without evidence of SMM are also common, and are significant markers of maternal morbidity in ways that are not yet fully understood. We assessed which demographic, clinical, and system-level factors are associated with postpartum readmission without evidence of SMM and if they differ from risk factors for postpartum readmissions with evidence of SMM.
Methods: We conducted a retrospective cohort study using All Payer All Claims Data (APAC) among persons age 15-44 with a hospital delivery in Oregon from 2012-2017. We estimated the associations between demographic (i.e. age and rurality), clinical (i.e. delivery route, comorbidities), and system-level factors (i.e. insurance type, hospital rurality) and postpartum readmissions up to 12 months from delivery discharge. We created two outcome measures – postpartum readmissions with evidence of SMM and without evidence of SMM. For each factor, we built multivariate models to estimate cumulative incidence ratios, controlling for confounders identified using directed acyclic graphs.
Results: The overall postpartum readmission rate within 12 months of delivery discharge was 1.8%. Of these, 84% had no evidence of SMM. Age was not associated with the risk of SMM-related readmissions. In contrast, people under the age of 24 were 44% more likely to be readmitted without evidence of SMM compared to those aged 25-29 (RR: 1.44; 95% CI: 1.32 – 1.57). Medicaid insurance at delivery was strongly associated with readmissions with SMM (RR: 12.87; 95% CI: 8.76, 18.92) and without SMM (RR: 9.85; 95% CI: 8.46, 11.46).
Conclusion: Drivers of postpartum readmissions differ depending on the presence of SMM. Our research shows that policies aimed at reducing postpartum morbidity delivery must address system level factors that lead to maternal health inequities.