The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65650

Emily Feinberg, Sc D¹, Jane Lazar², Rebecca E. Goldstein, ScM³, Maxine Schuster, PhD⁴, and Angela Nannini, FNP, PhD³. (1) Department of Maternal and Child Health, Boston University School of Public Health, Talbot Building - 5W, 715 Albany St, Boston, MA 02118, 617-414-3667, emily.feinberg@bmc.org, (2) Data Coordinating Center, Boston University School of Public HEalth, 715 Albany Street, 580, Boston, MA 02118-2526, (3) Bureau of Family and Community Health, Massachusetts Department of Public Health, 250 Washington Street, 5th floor, Boston, MA 02108, (4) Division of Health Care Finance & Policy, 2 Boylston St, Boston, MA 02116

Objective: We combined qualitative and quantitative methods to investigate access to care among low-income, postpartum, immigrant women in Massachusetts.

Background: Massachusetts coverage for pregnant low-income women who do not qualify for comprehensive Medicaid benefits ends 60 days postpartum. The majority of these women are new immigrants who face dual barriers of poor English proficiency and limited knowledge of how to navigate the health care system.

Methods: The study design includes conducting focus groups, linking data and using this linked data file to analyze postpartum hospitalizations.

Qualitative: Statewide focus groups, conducted in the participants' native languages, explore the impact of termination of health insurance coverage among distinct geographic and cultural communities.

Quantitative: We linked low-income women’s hospitalizations from delivery to up to a year postpartum for women who delivered in Massachusetts from 1998-2000. These linked data allowed us to identify and analyze preventable hospitalizations (PH), a marker of limited access to preventive services. We expanded the definition of PH to include psychiatric and substance abuse hospitalizations, which could have been prevented with adequate access to outpatient counseling services.

Results: Ongoing focus groups will provide insight into how low-income, immigrant women obtained medical care for themselves and their babies after their state-sponsored health insurance coverage ended.

We linked a total of 52,047 low-income women who delivered from 1998-2000 to 4,720 hospitalizations within a year postpartum. We will present analyses of differences in rates and types of PH among low-income immigrant women who lose insurance coverage compared to a sample who maintain comprehensive health benefits.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Describe an approach to combining qualitative and quantitative methods to investigate access to care among low income childbearing immigrant women.
• Describe the role of qualitative findings in informing quantitative analyses
• Describe the role of linked data sets in studying childbearing immigrant women
• Describe the role of hospital discharge data and the use of preventable hospitalizations as an approach to measuring access to care

Keywords: Access Immigration, Women's Health

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Contract with the Massachusetts Department of Public Health, which administers the state's Healthy Start Program. The woman who are the focus of this project were Healthy Start participants.