The association of patient and clinician demographics and concordance with medicaid sterilization consent form validity

The association of patient and clinician demographics and concordance with medicaid sterilization consent form validity

Research Paper

Lisa Jackson-Moore, Kim Malloy, Gene Urrutia, Kristen A. Berg, Emily S. Miller, Margaret Boozer, Tania Serna, Jennifer L. Bailit, Suzanna Larkin, Kavita Shah Arora

Journal of the National Medical Association, 23 May 2025

Abstract

Objective(s)

To evaluate the association between patient demographics, clinician demographics, and concordance of patient-clinician demographics and Medicaid sterilization consent form validity, defined as the waiting period having elapsed.

Study Design

Secondary analysis of a large, multi-center retrospective cohort study. This analysis included patients with Medicaid insurance desiring postpartum permanent contraception across three study sites. Our primary outcome was Medicaid sterilization consent form validity. Patient demographics were abstracted from the electronic medical record. Clinician demographics were obtained both through self- and peer-report. Descriptive, random effects modeling, and multivariable logistic regression analyses were utilized.

Results

Of the 1644 patients delivered by 124 clinicians in our cohort, 840 (51 %) had a valid Medicaid sterilization consent form. Descriptively, patients who were Black, unmarried, and not college educated were more likely to have valid forms (p < 0.001). The religious affiliation of the clinician (p < 0.001), but no other clinician characteristics, was associated with form validity. In multivariable models, patients who were of a different racial identity than their clinicians were more likely to have a valid form (aOR 1.32, 95 % confidence interval (CI) 1.05–1.66).

Conclusion(s)

While unable to determine the causes of our findings, the differential proportion of Medicaid sterilization consent form validity based on patient characteristics is concerning. Differences in form validity based on patient-clinician racial and ethnic concordance is deserving of further study.