Résumé :
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[BDSP. Notice produite par INIST e94R0x1C. Diffusion soumise à autorisation]. Context. - The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. Objective. - To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994. Design. - Before and after retrospective cohort analysis. Setting and Population. - Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare). Outcome Measures. - Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life. Results. - Tennessee residents had 72 014 study births in 1993 and 72 278 in 1995, of which 37 543 (52.1%) and 35 707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women. (...)
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