The data source for this dashboard is a commercial claims database, CDM. CDM is a database of administrative health claims for members of large commercial health plans across 50 US states, which is statistically de-identified under the Expert Determination method consistent with HIPAA and managed according to Optum® customer data use agreements. 

To establish our study population, we identified all inpatient deliveries resulting in a live birth from 2016-2020 in CDM. We created a patient-level cohort of individuals with continuous enrollment in a single health plan for 12 months before and 12 months after delivery, and with a maternal age of 15-44.¹ We chose this two-year time window given uncertainty about pregnancy length and timing surrounding conception,² noting that 12 months represents a common timeframe in antenatal research. All cohort identification, diagnosis, and procedure codes appear in Appendix 2. 

We identified and included hospital deliveries using standardized International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis and procedure codes, Diagnosis-Related Group (DRG) codes, and Current Procedural Terminology (CPT) codes.^2-4

We identified anxiety and depression diagnoses at any point during the two-year observation period surrounding delivery using Healthcare Cost and Utilization Project algorithms based on ICD-9-CM and ICD-10-CM codes.^5,6 

• Psychotherapy visits: at least one medical claim with a CPT code for psychotherapy 
• Antidepressant use: at least one pharmacy claim with evidence of an antidepressant class drug code
• Substance use disorder or opioid use disorder (SUD/OUD): at least one inpatient or two outpatient claims with ICD code(s) related to substance use disorders
• Suicidality: at least one claim with ICD codes related to suicidal ideation or self-harm. Please note this metric does not measure suicide events, rather it reflects suicidal ideation
• Cesarean delivery: defined using CPT and DRG codes related to cesarean delivery
• Severe maternal morbidity (SMM): identified using diagnosis and procedure codes described by the US Centers for Disease Control and Prevention. We did not include blood transfusion procedures in our measure.
• NICU: any medical services claim with CPT codes related to NICU
• PTB: any claims with ICD codes related to pre-term birth

All codes appear in the State Profile Appendix.

We restricted all analyses for this report to states that have at least 500 total deliveries in CDM across the 2016-2020 study period.

Each page will show two maps and one graph:

• National map of the rate of PMAD amongst all delivering individuals for each state for a selected year
• National map of the rate of the outcome of interest amongst all delivering individuals with PMAD for the selected year
• Trend lines for the outcome of interest amongst all deliveries, those with PMAD, and those without PMAD

Use the filters to adjust the outcome viewed and the year.

Hover the mouse over a part of the map for more detailed information about that state.

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