Journal ArticleDOI
Intrapartum obstetric care in the United States military: Comparison of military and civilian care systems within TRICARE.
Anju Ranjit,Wei Jiang,Tiannan Zhan,Linda G. Kimsey,Bart Staat,Catherine Witkop,Sarah E Little,Adil H. Haider,Julian N. Robinson +8 more
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TLDR
Direct care has a higher vaginal delivery rate but also a higher rate of common complications compared with purchased care, which may have potential use as a surrogate for comparing obstetric care between salary-based systems and fee-for-service systems in the United States.Abstract:
Background
Expectant mothers who are beneficiaries of TRICARE (universal insurance to United States Armed Services members and their dependents) can choose to receive care within direct (salary-based) or purchased (fee-for-service) care systems. We sought to compare frequency of intrapartum obstetric procedures and outcomes such as severe acute maternal morbidity (SAMM) and common postpartum complications between direct and purchased care systems within TRICARE.
Methods
TRICARE (2006-2010) claims data were used to identify deliveries. Patient demographics, frequency of types of delivery (noninstrumental vaginal, cesarean, and instrumental vaginal), comorbid conditions, SAMM, and common postpartum complications were compared between the two systems of care. Multivariable models adjusted for patient clinical/demographic factors determined the odds of common complications and SAMM complications in purchased care compared with direct care.
Results
A total of 440 138 deliveries were identified. Compared with direct care, purchased care had higher frequency (30.9% vs 25.8%, P<.001) and higher adjusted odds (aOR 1.37 [CI 1.34-1.38]) of cesarean delivery. In stratified analysis by mode of delivery, purchased care had lower odds of common complications for all modes of delivery (aOR[CI]:noninstrumental vaginal: 0.72 [0.71-0.74], cesarean: 0.71 [0.68-0.75], instrumental vaginal: 0.64 [0.60-0.68]) than direct care. However, purchased care had higher odds of SAMM complications for cesarean delivery (aOR 1.31 [CI 1.19-1.44]) compared with direct care.
Conclusion
Direct care has a higher vaginal delivery rate but also a higher rate of common complications compared with purchased care. Study of direct and purchased care systems in TRICARE may have potential use as a surrogate for comparing obstetric care between salary-based systems and fee-for-service systems in the United States.read more
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References
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An Enhanced Method for Identifying Obstetric Deliveries: Implications for Estimating Maternal Morbidity
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Toby Gosden,Frode Forland,Ivar Sønbø Kristiansen,Matt Sutton,Brenda Leese,Antonio Giuffrida,Michelle Sergison,Lone Pedersen +7 more
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Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality And Cost Issues
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