Elizabeth Boggs

Objective: Rural residents experience higher rates of postpartum uninsurance than their urban counterparts, contributing to rural–urban disparities in maternal health outcomes. We examined how Medicaid expansion under the Affordable Care Act affected rural–urban disparities in the rates of postpartum health insurance coverage among low-income women. Methods: We used nationally representative data from the 2010-2012 and 2015-2019 American Community Survey to compare rates of postpartum health insurance coverage among low-income women in states that expanded Medicaid and states that did not expand Medicaid (difference-in-differences analysis). We analyzed changes in disparities in postpartum health insurance coverage between women living in rural areas and women living in urban areas (difference-in-difference-in-differences analysis). Results: Women living in rural areas had the greatest increases in postpartum health insurance coverage, with a 17.0 percentage-point increase in states that expanded Medicaid (95% CI, 13.9-20.2) and an 11.5 percentage-point increase in states that did not expand Medicaid (95% CI, 9.2-13.8). Any postpartum health insurance coverage among rural residents relative to urban residents increased by 4.8 percentage points (95% CI, 2.0-7.7) in states that expanded Medicaid compared with states that did not. We observed similar trends for Medicaid postpartum health insurance coverage specifically. Conclusions: Rural women had greater increases in postpartum health insurance coverage relative to urban women following Medicaid expansion, thereby reducing geographic disparities in health insurance coverage during the postpartum period. Future research should focus on whether disproportionate gains in health insurance coverage for rural communities led to increased access to care during the postpartum period.

Background: Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow‐up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow‐up reduces risk of readmission for patients with Medicaid.Objective: To assess whether follow‐up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status.Methods: This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow‐up, and readmission.We analyzed data from 4281 patients aged 21–64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission.Outpatient follow‐up within 30 days of discharge and 30‐day all‐cause readmission were outcomes.Results: Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow‐up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow‐up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91–1.32) in the overall sample or in analysis stratified by payer.Conclusions: We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow‐up. Timely follow‐up care alone may not be sufficient as an intervention to reduce readmissions.

Primary hyperparathyroidism (pHPT) is a rare clinical entity in pediatric patients relative to adults. Consequently, the diagnosis is often delayed in pediatric patients, and children and adolescents are more likely to present with symptoms of hypercalcemia and end-organ damage. Here, we present the case of an adolescent patient with chest pain who was found to have a lytic bone lesion secondary to pHPT.

*Corresponding Author: Elizabeth Boggs, MD, MS; Email: Elizabeth.boggs@cuanschutz.edu; Twitter: @efboggs52

To describe the prevalence, types, and trends over time of medical technology assistance (TA) in patients at the age of transition to adult care with childhood onset chronic conditions (COCCs) cared for at children’s hospitals. In this retrospective repeated annual cross-sectional cohort study of the Pediatric Health Information Systems inpatient data, patients with at least 1 hospitalization from January 1, 2008, to December 31, 2018 with a selected COCC were included. The COCCs investigated were brain and spinal cord malformation, cerebral palsy, heart and great vessel malformation, cystic fibrosis, sickle cell anemia, and chronic renal failure. TA was defined as requiring an indwelling medical device to maintain health status. Trends over time in TA were analyzed with the Cochran–Armitage test and generalized linear models. During the study, 381 289 unique patients accounted for 940 816 hospitalizations. Transition-aged patients (19–21 years old) represented 2.4% of all included hospitalizations over the 11-year period, whereas patients ages 21 and above represented 2.7%. The annual proportion of patients with TA increased significantly from 31.3% in 2008 to 36.9% in 2018, a 17.9% increase (P < .001). In this cohort of patients with select COCCs hospitalized at children’s hospitals, a substantial and growing number of patients at the age of transition to adult care required TA. Identifying adult providers with resources to manage COCCs and maintain medical devices placed in childhood is challenging. These trends warrant special attention to support the timely and successful transition of medically complex patients from pediatric to adult care.