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Drivers of Hospital Length of Stay in Medicaid and Commercially Insured Mother-Infant Pairs With a Diagnosis of Neonatal Abstinence Syndrome

Parlett, Lauren BS, PhD*; Agiro, Abiy BS, MHS, PhD; Brown, Susan MD, FAAP; Wilt, Mary BSN, RN; Portzline, Amy BSN, MSN, RNC-MNN; Verburg, Jacqueline RN; Shea, Karen MSN; DeVries, Andrea PhD§

doi: 10.1097/MLR.0000000000001199
Patient-centered Care

Background: The occurrence of neonatal abstinence syndrome (NAS) mirrors the growing opioid epidemic in the United States. As Medicaid covers a majority of cases, the commercially insured population has largely been ignored for NAS risk.

Objective: The objective of this study was to examine Medicaid and commercially insured mother-infant pairs to determine demographic and clinical characteristics associated with NAS length of stay (LOS).

Research Design: This observational, descriptive case-series study utilized administrative claims from HealthCore Integrated Research Database to measure maternal characteristics for 6 months before delivery, and neonatal characteristics and health care service utilization for 3 months after NAS diagnosis. Bootstrapped regressions were used to model LOS.

Results: The sample included 1807 mother-infant pairs. Most infants (79%) had Medicaid coverage (Medicaid: N=1419; Commercial: N=388). Although all infants had NAS, Medicaid-insured mothers had more prevalent drug abuse (70.8% vs. 41.0%; P<0.0001), but fewer used prescription opioids (45.3% vs. 60.8%; P<0.0001) compared with commercially insured mothers. Commercially insured infants were sicker, with a higher prevalence of complex chronic conditions, and yet Medicaid-insured infants were admitted to neonatal intensive care unit at a much higher rate (91.1% vs. 78.9%; P<0.0001). After adjustment, neonatal intensive care unit admission (+6.7 d, 95% confidence interval: 4.5–9.3) and chronic complex conditions (+5.2 d, 95% confidence interval: 3.8–6.6) contributed most to LOS.

Conclusion: A re-evaluation of obstetrical management towards a focus on the history of possible opioid and substance use regardless of insurance type and demographic background might inform efforts to reduce LOS.

*Translational Research for Affordability and Quality, HealthCore Inc., Alexandria, VA

Translational Research for Affordability and Quality, HealthCore Inc., Wilmington, DE

Maternal Child Services, Government Business Division, Anthem Inc., Norfolk, VA

§Translational Research for Affordability and Quality, HealthCore Inc., Pittsburgh, PA

Supported by Anthem Inc.

All authors were employed by Anthem Inc. or HealthCore, a wholly owned subsidiary of Anthem Inc. The authors and their respective institutions did not receive payment or services from a third party for any aspect of the submitted work. Beyond their salaries, none of them received any compensation for their role in the study, and have no conflict of interest to disclose.

Reprints: Abiy Agiro, BS, MHS, PhD, Translational Research for Affordability and Quality, HealthCore Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801-5134. E-mail:

Online date: September 18, 2019

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