Determining Compliance of Contraception Guidelines for Women By: - - PowerPoint PPT Presentation

β–Ά
determining compliance of
SMART_READER_LITE
LIVE PREVIEW

Determining Compliance of Contraception Guidelines for Women By: - - PowerPoint PPT Presentation

May 23, 2023 204 likes β€’510 views

Determining Compliance of Contraception Guidelines for Women By: Toyya Pujol-Mitchell Advisor: Dr. Nicoleta Serban Motivation PREGNANCIES BY INTENTION STATUS Unintended Nearly half of U.S. pregnancies were Pregnancies Lead to unintended in

slide-1
SLIDE 1

Determining Compliance of Contraception Guidelines for Women

By: Toyya Pujol-Mitchell Advisor: Dr. Nicoleta Serban

slide-2
SLIDE 2

Motivation

PREGNANCIES BY INTENTION STATUS Nearly half of U.S. pregnancies were unintended in 2011

Intended Mistimed Unwanted

18% 55% 27%

Unintended Pregnancies Lead to Worse Outcomes

Poor Outcomes Are Exacerbated by Health Conditions

2

slide-3
SLIDE 3

Background

  • In 2010, Centers for Disease Control and Prevention (CDC)

released safety recommendations for contraceptive use

  • Medical Eligibility Criteria for Contraceptive Use (MEC)
  • Scope for contraceptives options for multiple medical conditions
  • Adapted for the US from the World Health Organization MEC
  • MEC recommended highly effective contraceptives for women

with high risk health conditions

  • 20 conditions include: hypertension, diabetes, stroke, and sickle cell

disease

  • Recommendation: Long-acting reversible contraceptive (LARC)

3

slide-4
SLIDE 4

Research Objectives

  • 1. Accurately identify women with these high risk health conditions

through administrative claims data

  • 2. Determine if clinicians are following the MEC guidelines
  • 3. Assess if LARC usage of women with chronic health conditions is

improving

  • 4. Compare rate to that of the total population

4

slide-5
SLIDE 5

Relevant Work

  • Reeves et al. (2014)
  • Determined most accurate method to identify sickle cell patients using claims data
  • Byrd et al. (2015)
  • Found which states in Medicaid data has most complete data
  • Dehlendorf et al. (2010) & Russo et al. (2015)
  • Found healthcare providers’ knowledge of contraceptives and MEC guidelines is low
  • Massad et al. (2007), Culwell et al. (2009), Lindley et al. (2010) & Sun et al. (2012)
  • Women with individual medical conditions have high rates of unintended pregnancies
  • Low levels of highly effective contraceptive provisions

5

slide-6
SLIDE 6

Data Overview

  • Medicaid Analytical Extract medical claims from Centers for

Medicare and Medicaid Services (CMS)

  • 4 billion claims
  • Inpatient (IP) claims, & other therapy (OT) claims
  • Focused on 2 years prior (2008 – 2009) and 2 years post (2011-2012)

release of guidelines

  • International Classification of Disease (ICD-9) codes
  • Current Procedural Terminology (CPT) Codes

6

slide-7
SLIDE 7

Identifying Patients

Methods & Results

slide-8
SLIDE 8

CMS Claims Data

8

Patient Medical Condition

Patient Information Provider Information CPT Codes ICD-9 Codes Service Dates

slide-9
SLIDE 9

Obtaining Study Population

  • Study population identified as patients who are:
  • 1. Enrolled in Medicaid in Phase 0 (2008 -2009) or Phase 1 (2011-2012)
  • 2. Females within reproductive age
  • 3. Have one or more of the high risk health conditions

9

20.70 23.55 19.00 19.50 20.00 20.50 21.00 21.50 22.00 22.50 23.00 23.50 24.00

Phase 0 Phase 1

Millions

Study Population: Females Enrolled in Medicaid

Total Females

slide-10
SLIDE 10

Determining Age

Females of reproductive age (10-49 years) determined by difference

  • f year of birth and current year in personal summary table

10

22.2 79.1 163.5 305.8 214.3 26.4 87.8 200.9 352.8 252.2

  • 50.0

100.0 150.0 200.0 250.0 300.0 350.0 400.0 10-14 15-24 25-34 35-44 45-49

Study Population: Age

Phase 0 Count Phase 1 Count

Thousands of People

slide-11
SLIDE 11

Identifying Surgery Patients

Surgery patients (Bariatric Surgery and Organ Transplant) were identified if procedure code was in an IP claim within a 2 year time period

11

Number of People

6,299 779 8,140 784

  • 1,000

2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 Bariatric Surgery Solid Organ Transplant

Study Population: Surgery Patients

Phase 0 Counts Phase 1 Counts

slide-12
SLIDE 12

Medical Patient Identification

  • 1. Identify all patients with at least one

claim with a medical condition ICD-9 code

  • 2. Obtain all IP and OT claims for patients

identified in step 1

  • 3. Identify medical patients by grouping

IP and OT claims together by condition

12

slide-13
SLIDE 13

Medical Condition Patients

13

Hypertension 41% Diabetes 31% Epilepsy 8% HIV 3% Ischemic Heart Disease 3% Lupus 3% Breast Cancer 3% Stroke 2% Remaining Condition 6%

PHASE 1 COUNTS

Hypertension 40% Diabetes 31% Epilepsy 8% HIV 4% Ischemic Heart Disease 3% Lupus 3% Breast Cancer 3% Stroke 2% Remaining Condition 6%

PHASE 0 COUNTS

slide-14
SLIDE 14

Final Study Population

Five percent of patients identified as having one of the 20 medical conditions

14

14.60 16.26 0.78 0.92 13.00 14.00 15.00 16.00 17.00 18.00

Phase 0 Phase 1

Millions

Study Population: Health Condition

Total Patient Counts Total Condition Counts

slide-15
SLIDE 15

Guideline Compliance

Methods & Results

slide-16
SLIDE 16

Establishing Outcomes

  • Outcome 1: Family planning ratio
  • Counseling, insertions, and surveillance for contraceptive methods

πœˆπ‘—π‘˜

1 = π‘œπ‘£π‘›π‘π‘“π‘  𝑝𝑔 π‘”π‘π‘›π‘—π‘šπ‘§ π‘žπ‘šπ‘π‘œπ‘œπ‘—π‘œπ‘• π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘

π‘’π‘π‘’π‘π‘š π‘œπ‘£π‘›π‘π‘“π‘  𝑝𝑔 π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘

  • Outcome 2: Highest efficacy method ratio
  • Intrauterine device (IUD): insertion & surveillance
  • Implants: insertion

πœˆπ‘—π‘˜

2 = π‘œπ‘£π‘›π‘π‘“π‘  𝑝𝑔 𝑀𝐡𝑆𝐷 π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘

π‘’π‘π‘’π‘π‘š π‘œπ‘£π‘›π‘π‘“π‘  𝑝𝑔 π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘

16

slide-17
SLIDE 17

Comparing Rates

Use Poisson means method 𝐼0: 𝜈0π‘˜

𝑙 βˆ’ 𝜌0 𝑙 = 𝜈1π‘˜ 𝑙 βˆ’ 𝜌1 𝑙

𝐼1: 𝜈0π‘˜

𝑙 βˆ’ 𝜌0 𝑙 < 𝜈1π‘˜ 𝑙 βˆ’ 𝜌1 𝑙

πœˆπ‘—π‘˜

𝑙 ∢ π‘žπ‘ π‘π‘žπ‘π‘ π‘’π‘—π‘π‘œ 𝑝𝑔 π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘ 𝑔𝑝𝑠 π‘žβ„Žπ‘π‘‘π‘“ 𝑗 π‘π‘œπ‘’ π‘›π‘“π‘’π‘—π‘‘π‘π‘š π‘‘π‘π‘œπ‘’π‘—π‘’π‘—π‘π‘œ π‘˜ 𝑝𝑔 𝑑𝑒𝑣𝑒𝑧 π‘žπ‘π‘žπ‘£π‘šπ‘π‘’π‘—π‘π‘œ

πœŒπ‘—

𝑙: π‘žπ‘ π‘π‘žπ‘π‘ π‘’π‘—π‘π‘œ 𝑝𝑔 π‘žπ‘π‘’π‘—π‘“π‘œπ‘’π‘‘ 𝑔𝑝𝑠 π‘žβ„Žπ‘π‘‘π‘“ 𝑗 𝑝𝑔 π‘‘π‘π‘œπ‘’π‘ π‘π‘š π‘žπ‘π‘žπ‘£π‘šπ‘π‘’π‘—π‘π‘œ

π‘žβ„Žπ‘π‘‘π‘“ 𝑗 ∈ (0,1) β„Žπ‘“π‘π‘šπ‘’β„Ž π‘‘π‘π‘œπ‘’π‘—π‘’π‘—π‘π‘œ π‘˜ ∈ 1,2, … 20 𝑝𝑣𝑒𝑑𝑝𝑛𝑓 𝑙 ∈ 1,2

17

slide-18
SLIDE 18

Outcome Adjustment Factors

NATIONAL LARC USAGE

Outcome 1: Overall contraceptive use has remained constant between the two phases (62%) Outcome 2: Increase in LARC usage in most recent years (4% to 7.2%)

18

slide-19
SLIDE 19

Increase in Both Outcomes

Based on the Poisson means test: The change of the family planning patient rate and LARC usage between phases is statistically significant

Outcome (Patients/Health Patients) Rate Before Rate After

Outcome 1: Family Planning

11.96% 13.16%

Outcome 2: LARC

1.13% 2.37%

19

slide-20
SLIDE 20

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

Percentage of Family Planning Patients by Condition

Phase 0 Phase 1

20

  • Outcome 1 significant medical

conditions:

  • Breast Cancer
  • Diabetes
  • Epilepsy
  • HIV
  • Ischemic Heart Disease
  • Lupus
  • Sickle Cell Disease
  • Thrombogenic Mutation
  • Valvular Heart Disease

Outcome 1: Inconsistent Increase

slide-21
SLIDE 21

Outcome 2: Consistent Increase

0.00% 2.00% 4.00% 6.00% 8.00% 10.00%

Percentage of LARC Patients by Condition

Phase 0 Phase 1

21

Outcome 2 significant medical conditions:

  • All conditions significant
slide-22
SLIDE 22

Conclusion

  • The proportion of women who receive family planning has increased
  • These women are also choosing LARC methods more frequently
  • LARC usage improved at both the aggregated and condition level
  • Family planning improved for some health conditions
  • Intervention should focus on conditions which have not seen

increase in family planning

22

slide-23
SLIDE 23

Future Work

  • Update adjustment factor to reflect derived Medicaid patient rates
  • Add sterilization to analysis
  • Make recommendations across other factors, such as age, state and

provider types

23

slide-24
SLIDE 24

Thank you

Toyya Pujol-Mitchell Georgia Institute of Technology Industrial & Systems Engineering Health Analytics Center pujol@gatech.edu

slide-25
SLIDE 25

APPENDIX

25

slide-26
SLIDE 26

20 Chronic Health Conditions

CDC Identified High-Risk Conditions for Unplanned Pregnancy Bariatric surgery HIV Peripartum Cardiomyopathy Stroke Breast Cancer Hypertension Schistosomiasis with Liver Fibrosis* Systemic Lupus Erythematosus Diabetes Ischemic heart Disease Severe Cirrhosis Thrombogenic Mutations Endometrial & Ovarian Cancer Malignant Gestational Trophoblastic Disease* Sickle Cell Disease Tuberculosis Epilepsy Malignant Liver Tumors* Solid Organ Transplant* Valvular Heart Disease

*Dropped from analysis due to low numbers

26

slide-27
SLIDE 27

States Under Consideration

14 states were included in analysis:

  • Alabama (AL)
  • Arkansas (AR)
  • California (CA)
  • Florida (FL)
  • Georgia (GA)
  • Louisiana (LA)
  • Mississippi (MS)
  • Minnesota (MN)
  • North Carolina (NC)
  • New York (NY)
  • Pennsylvania (PA)
  • South Carolina (SC)
  • Tennessee (TN)
  • Texas (TX)

27

slide-28
SLIDE 28

Chronic Conditions Codes

# Condition ICD-9 code

1breast cancer 174 2diabetes 250 3endometrial & ovarian cancer 179, 182, 183 4epilepsy 345 5HIV 042 6hypertension 401-405 7ischemic heart 410, 412-414 8malignant gestational trophoblastic disease 181 9 malignant liver tumors and hepatocellular carcinoma

  • f the liver

155 10peripartum cardiomyopathy 674.5 11schistosomiasis with fibrosis of the liver 120.9 12severe cirrhosis 571 13sickle cell 282.6 14stroke 430-434 15systemic lupus erythematosus 710.0 16thrombogenic mutations 286 17tuberculosis 010-018 18valvular heart disease 424

# Condition Procedure Codes

19Bariatric Surgery 4468, 4469, 4591,4389,4551,4439,4450,4370,4438,4495 20Solid Organ Transplant 3751, 5051, 5059,3350,3351,3353,5282,5280,5283, 5569

28

slide-29
SLIDE 29

Contraceptive ICD-9 Codes

Outcome V25 ICD-9 Codes

Family Contraceptive Counseling

V25*

Highest Efficacy Method

V25.11, V25.13, V25.42, V25.43, V25.5

29