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Strengthen the Evidence for Maternal and Child Health Programs

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Displaying records 1 through 8 (8 total).

Adams EK, Kenney GM, Galactionova K. Preventive and reproductive health services for women: the role of California’s family planning waiver. Am J Health Promot. 2013;27(3 Suppl):eS1-eS10. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: The present study uses a quasi-experimental design using data from the California Women's Health Survey and the Behavioral Risk Factor Surveillance System (BRFSS) for exposure and comparison groups, before and after California's Planning Access Care and Treatment waiver.
Primary Outcomes: Percentage of women with a Pap smear in the past year
Conclusion: The waiver appears to have led to a reduction in pregnancy rates and increased receipt of reproductive health care, particularly routine checkups.
Study Design: QE: pretest-posttest non-equivalent control group
Significant Findings: No
Setting: California
Target Audience: Women in California with incomes under 200% of the Federal Poverty Level (FPL)
Data Source: California Women’s Health Survey and Behavioral Risk Factor Surveillance System
Sample Size: California Women’s Health Survey: Pre-waiver Intervention group ranges from n=220 to n=1,971 Control group ranges from n=206 to n=1,598 Post-waiver Intervention group ranges from n=399 to n=4,123 Control group ranges from n=497 to n=2,782 Behavioral Risk Factor Surveillance System: Pre-waiver Intervention (n=1,735); Control (n=2,564) Post-waiver Intervention (n=3,750); Control (n=10,963)
Age Range: 18-44

Wright BJ, Conlin AK, Allen HL, Tsui J, Carlson MJ, Li HF. What does Medicaid expansion mean for cancer and prevention? Results from a randomized trial on the impacts of acquiring Medicaid coverage. Cancer. 2016;122(5):791-7. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: The authors prospectively followed a representative panel of 16,204 individuals from the Oregon Medicaid lottery reservation list, collecting data before and after the Medicaid lottery drawings. The study panel was divided into 2 groups: a treatment group of individuals who were selected in the Medicaid lottery (6254 individuals) and a control group who were not (9950 individuals). The authors also created an elevated risk subpanel based on family cancer histories. One year after the lottery drawings, differences in cancer screening rates, preventive behaviors, and health status were compared between the study groups.
Primary Outcomes: 1) Percentage of women who self-reported receiving a Pap test within the last year 2) Percentage of women who self-reported having received the HPV vaccine 12 months following the intervention
Conclusion: Medicaid coverage did not appear to directly impact lifestyle choices that might reduce cancer risk, but it did provide access to important care and screenings that could help to detect cancers earlier. These findings could have long-term population health implications for states considering or pursuing Medicaid expansion. Cancer 2016;122:791-797. © 2015 American Cancer Society.
Study Design: Prospective RCT
Setting: Oregon
Target Audience: Low-income, nondisabled, uninsured females who signed up for the Oregon Medicaid lottery reservation list7 Elevated risk subpanel: participants who reported, either for themselves or a close relative, a prior diagnosis of breast, ovarian, uterine, colon, or prostate cancer
Data Source: 1) Computerized administrative data 2) Written surveys distributed via mail
Sample Size: Total Panel at Baseline (n=4,023)8  Intervention (n=1,526)  Control (n=2,497) Elevated Risk Subpanel at Baseline (n=1,042)  Intervention (n=410) Control (n=632)
Age Range: 18-31

Sabik LM, Bradley CJ. The impact of near-universal insurance coverage on breast and cervical cancer screening: evidence from Massachusetts. Health Econ. 2016;25(4):391-401. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: The effect of expansion to near-universal health insurance coverage in Massachusetts on breast and cervical cancer screening. We use data from 2002 to 2010 to compare changes in receipt of mammograms and Pap tests in Massachusetts relative to other New England states.
Primary Outcomes: Number of Pap tests received in the pre-reform/implementation period and the post-reform period
Conclusion: Overall, Massachusetts health reform appears to have increased breast and cervical cancer screening, particularly among low-income women. Our results suggest that reform was successful in promoting preventive care among targeted populations.
Study Design: QE: pretest-posttest non-equivalent control group
Significant Findings: Yes
Setting: Massachusetts
Target Audience: Women with no history of hysterectomy
Data Source: Behavioral Risk Factor Surveillance System
Sample Size: Baseline (n=34,874) Intervention (n=9,514); Control (n=25,360) Follow-up (n=31,018) Intervention (n=11,483); Control (n=19,535)
Age Range: 21-64

Wharam JF, Galbraith AA, Kleinman KP, Soumerai SB, Ross-Degnan D, Landon BE. Cancer screening before and after switching to a high-deductible health plan. Ann Intern Med. 2008;148(9):647-55. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Cost-Sharing Requirements
Intervention Description: To determine the effect of membership in a high-deductible health plan on cervical, breast, and colorectal cancer screening.
Primary Outcomes: Percentage of women with at least one registered Pap test during baseline and follow-up
Conclusion: Members of a high-deductible health plan did not seem to change their use of breast, cervical, and colorectal cancer screening when tests were fully covered. However, members may have substituted a fully covered screening test (FOBT) for tests subject to the deductible (colonoscopy, flexible sigmoidoscopy, and DCBE).
Study Design: QE: pretest-posttest non-equivalent control group
Significant Findings: No
Setting: Massachusetts
Target Audience: Women with no history of hysterectomy, who were enrolled in Harvard Pilgrim Health Care through their employers for at least 2 years
Data Source: Harvard Pilgrim Health Care’s claims database
Sample Size: Total (N=23,089) Intervention (n=2,375); Control (n=20,714)
Age Range: 21-64

Lipton BJ, Decker SL. ACA provisions associated with increase in percentage of young adult women initiating and completing the HPV vaccine. Health Affairs. 2015;34(5):757-764. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, Cost-Sharing Requirements
Intervention Description: Affordable Care Act provisions implemented in 2010 required insurance plans to offer dependent coverage to people ages 19–25 and to provide targeted preventive services with zero cost sharing. These provisions both increased the percentage of young adults with any source of health insurance coverage and improved the generosity of coverage. We examined how these provisions affected use of the human papillomavirus (HPV) vaccine, which is among the most expensive of recommended vaccines, among young adult women.
Primary Outcomes: Percentage of women with self-reported initiation of the HPV vaccine series before and after implementation of the intervention.
Conclusion: These estimates translate to approximately 1.1 million young women initiating and 854,000 young women completing the vaccine series.
Data Source: National Health Interview Survey

Roblin D, Ritzwoller D, Rees D, Carroll N, Chang A, Daley M. The influence of deductible health plans on receipt of the human papillomavirus vaccine series. J Adolesc Health. 2014;54(3):275-281. Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Cost-Sharing Requirements
Intervention Description: To evaluate whether enrollment in deductible health plans (DHP) with higher patient cost-sharing requirements than traditional health maintenance organization plans (HMP) decreased initiation and completion of the human papillomavirus (HPV) vaccine series recommended for prevention of cervical cancer.
Primary Outcomes: Percentage of patients who initiated the HPV vaccine series during the study period.
Conclusion: Enrollment in a DHP versus an HMP did not directly affect initiation or completion of the HPV vaccine series among age-eligible females. Independent of plan type, more frequent primary care visits increased initiation and completion rates.
Data Source: Computerized administrative data

Gibbs, S., Harvey, S. M., Bui, L., Oakley, L., Luck, J., & Yoon, J. (2020). Evaluating the effect of Medicaid expansion on access to preventive reproductive care for women in Oregon. Preventive medicine, 130, 105899. https://doi.org/10.1016/j.ypmed.2019.105899 Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: First, we compared service receipt among continuing Medicaid enrollees pre- and post-ACA. We then compared receipt among new post-ACA Medicaid enrollees to receipt by continuing enrollees after ACA implementation. Using Medicaid enrollment and claims data, we identified well-woman visits, contraceptive counseling, contraceptive services, sexually transmitted infection (STI) screening, and cervical cancer screening among women ages 15–44 in years when not pregnant. For pre-ACA enrollees, we assessed pre-ACA receipt in 2011–2013 (n = 83,719) and post-ACA receipt in 2014–2016 (n = 103,225). For post-ACA enrollees we similarly assessed post-ACA service receipt (n = 73,945) and compared this to service receipt by pre-ACA enrollees during 2014–2016.
Conclusion: Despite small declines in receipt of several preventive reproductive services among prior enrollees, the ACA resulted in Medicaid financing of these services for a large number of newly enrolled low-income women in Oregon, which may eventually lead to population-level improvements in reproductive health. These findings among women in Oregon could inform Medicaid coverage efforts in other states.
Significant Findings: no
Setting: Oregon state Medicaid expansion program
Target Audience: Low-income non-pregnant women aged 15–44 enrolled in Oregon's Medicaid program in 2011–2016

Garrido, C. O., Coşkun, R. A., Lent, A. B., Calhoun, E., & Harris, R. B. (2020). Use of cervical cancer preventive services among US women aged 21-29: an assessment of the 2010 Affordable Care Act rollout through 2018. Cancer causes & control : CCC, 31(9), 839–850. https://doi.org/10.1007/s10552-020-01325-w Access Abstract

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: Using multi-year responses from the Behavioral Risk Factor Surveillance System, we examined the association between the ACA and participation in and adherence to Pap testing and HPV vaccination behaviors as set by the ACS. The sample included women aged 21–29 who completed the survey between 2008 and 2018 (every other year) and who live in 24 US States (N = 37,893).
Conclusion: Findings raise concerns around declines in the proportion of women receiving and adhering to Pap testing guidelines. A need exists for research to examine the role of increases in HPV vaccination uptake on decreases in Pap testing. Moreover, effective strategies should target increases in cervical cancer screening uptake among women vaccinated against HPV.
Significant Findings: no
Setting: U.S. healthcare system
Target Audience: Women ages 21-29 who lived in U.S. and completed BRFSS survey

   

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.