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Care Management and Racial Disparities in Hypertensive Disorders of Pregnancy Among Medicaid Enrollees in North Carolina
Care Management and Racial Disparities in Hypertensive Disorders of Pregnancy Among Medicaid Enrollees in North Carolina
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202103634
- ISBN
- 9798291561652
- DDC
- 614
- 저자명
- Aijaz, Monisa.
- 서명/저자
- Care Management and Racial Disparities in Hypertensive Disorders of Pregnancy Among Medicaid Enrollees in North Carolina
- 발행사항
- [Sl] : The University of North Carolina at Chapel Hill, 2025
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2025
- 형태사항
- 128 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 87-02, Section: B.
- 주기사항
- Advisor: Shea, Christopher M.;Planet, Arrianna Marie.
- 학위논문주기
- Thesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2025.
- 초록/해제
- 요약Racial and ethnic inequities in hypertensive disorders of pregnancy persist, with low-income people of color experiencing preeclampsia or eclampsia at 69.8 per 1000 deliveries, compared to 43.3 per 1000 for White birthing individuals. The reasons for these differences are unclear, but social factors tied to historical marginalization and unequal access to services may drive inequities. Since 2011, North Carolina's Medicaid has implemented a pregnancy medical home program, incentivizing providers to conduct standardized risk screenings for clinical and social needs and provide individualized care management. However, little focus has been placed on understanding the utilization and impact of care management services on hypertensive disorders of pregnancy among racial and ethnic groups. To address these gaps, I utilized a dataset spanning 2017-2019, which included North Carolina Medicaid claims, birth certificates, risk screening and care management data, and the US Census Bureau's American Community Survey (2016-2020). I chose this period because the program began new risk scoring in 2017, and the pandemic disrupted in-person non-emergency services after February 2020. Also, North Carolina's Medicaid program moved to managed care in 2021, preserving universal risk screening and care management but ending the data reporting system. In Aim 1, I examined the association between neighborhood deprivation, measured by the Index of Concentration of the Extremes, and the timeliness of patient entry into care, risk screening completion, and face-to-face care management among Medicaid enrollees with ≥1 preeclampsia risk factor using multivariate logistic regression models. In Aim 2, I examined the effect of ≥5 face-to-face care management visits on preeclampsia onset among Medicaid enrollees with ≥1 preeclampsia risk factor using a bivariate probit model. In Aim 3, I examined racial disparities in face-to-face care management services for those with ≥1 preeclampsia risk factor using generalized linear and probit models, implementing the Institute of Medicine (IOM) model for measuring disparities. This research demonstrates that neighborhood deprivation restricts access to prenatal services, informing targeted interventions. It highlights the effectiveness of care management services in reducing racial disparities in hypertensive disorders of pregnancy, illustrating how programs like pregnancy medical homes can integrate equity measures in evaluations to improve health outcomes for everyone.
- 일반주제명
- Health sciences
- 일반주제명
- Obstetrics
- 일반주제명
- Public health
- 키워드
- Care management
- 키워드
- Medicaid
- 키워드
- Preeclampsia
- 기타저자
- The University of North Carolina at Chapel Hill Health Policy and Management
- 기본자료저록
- Dissertations Abstracts International. 87-02B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■020 ▼a9798291561652
■035 ▼a(MiAaPQ)AAI32047305
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a614
■1001 ▼aAijaz, Monisa.
■24510▼aCare Management and Racial Disparities in Hypertensive Disorders of Pregnancy Among Medicaid Enrollees in North Carolina
■260 ▼a[Sl]▼bThe University of North Carolina at Chapel Hill▼c2025
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2025
■300 ▼a128 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 87-02, Section: B.
■500 ▼aAdvisor: Shea, Christopher M.;Planet, Arrianna Marie.
■5021 ▼aThesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2025.
■520 ▼aRacial and ethnic inequities in hypertensive disorders of pregnancy persist, with low-income people of color experiencing preeclampsia or eclampsia at 69.8 per 1000 deliveries, compared to 43.3 per 1000 for White birthing individuals. The reasons for these differences are unclear, but social factors tied to historical marginalization and unequal access to services may drive inequities. Since 2011, North Carolina's Medicaid has implemented a pregnancy medical home program, incentivizing providers to conduct standardized risk screenings for clinical and social needs and provide individualized care management. However, little focus has been placed on understanding the utilization and impact of care management services on hypertensive disorders of pregnancy among racial and ethnic groups. To address these gaps, I utilized a dataset spanning 2017-2019, which included North Carolina Medicaid claims, birth certificates, risk screening and care management data, and the US Census Bureau's American Community Survey (2016-2020). I chose this period because the program began new risk scoring in 2017, and the pandemic disrupted in-person non-emergency services after February 2020. Also, North Carolina's Medicaid program moved to managed care in 2021, preserving universal risk screening and care management but ending the data reporting system. In Aim 1, I examined the association between neighborhood deprivation, measured by the Index of Concentration of the Extremes, and the timeliness of patient entry into care, risk screening completion, and face-to-face care management among Medicaid enrollees with ≥1 preeclampsia risk factor using multivariate logistic regression models. In Aim 2, I examined the effect of ≥5 face-to-face care management visits on preeclampsia onset among Medicaid enrollees with ≥1 preeclampsia risk factor using a bivariate probit model. In Aim 3, I examined racial disparities in face-to-face care management services for those with ≥1 preeclampsia risk factor using generalized linear and probit models, implementing the Institute of Medicine (IOM) model for measuring disparities. This research demonstrates that neighborhood deprivation restricts access to prenatal services, informing targeted interventions. It highlights the effectiveness of care management services in reducing racial disparities in hypertensive disorders of pregnancy, illustrating how programs like pregnancy medical homes can integrate equity measures in evaluations to improve health outcomes for everyone.
■590 ▼aSchool code: 0153.
■650 4▼aHealth sciences
■650 4▼aObstetrics
■650 4▼aPublic health
■653 ▼aCare management
■653 ▼aHypertensive disorders of pregnancy
■653 ▼aMedicaid
■653 ▼aNeighborhood deprivation
■653 ▼aPreeclampsia
■653 ▼aRacial differences
■690 ▼a0566
■690 ▼a0380
■690 ▼a0573
■71020▼aThe University of North Carolina at Chapel Hill▼bHealth Policy and Management.
■7730 ▼tDissertations Abstracts International▼g87-02B.
■790 ▼a0153
■791 ▼aPh.D.
■792 ▼a2025
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17358033▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
