Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD)

患有围产期情绪和焦虑症 (PMAD) 的私人受保女性的心理健康保险与结果之间的关系

• 批准号: 10197277
• 负责人: Kara Zivin
• 金额: $ 23.38万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-08 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197277
• 关键词: Accidental Injury; Address; Administrative Supplement; Adoption; Affect; Alcohol or Other Drugs use; American; Anxiety Disorders; Awareness; Caring; Cessation of life; Clinical; Data Mart; Death Certificates; Detection; Developed Countries; Diagnosis; Enrollment; Ethnic Origin; Face; Feeling suicidal; Funding; Future; Generations; Grant; Health; Health Benefit; Health Insurance; Health Policy; Health Services; Health system; Healthcare; Homicide; Hospitalization; Income; Infant; Insurance; Insurance Coverage; Intervention; Laws; Life; Low income; Maternal Health; Maternal Mortality; Measurement; Medical; Mental Health; Mood Disorders; Mothers; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Overdose; Patients; Perinatal; Perinatal mortality demographics; Pharmaceutical Preparations; Policies; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Procedures; Quality of Care; Race; Reporting; Research; Risk; Sampling; Savings; Self-Injurious Behavior; Services; Statutes and Laws; Subgroup; Substance Use Disorder; Suicide; Suicide attempt; United States; United States National Institutes of Health; Vision; Vulnerable Populations; Woman; Work; addiction; base; behavior influence; behavioral health; cohort; cost; economic outcome; experience; health care delivery; health plan; high risk; high risk population; improved; innovation; insight; interest; intergenerational; mortality; multiple data sources; parity; perinatal outcomes; perinatal period; population based; pregnancy related death; prevent; racial diversity; self diagnosis; severe maternal morbidity; statistics

This study directly responds to Notice of Special Interest (NOSI): Administrative supplements for NIH grants to add or expand research focused on maternal mortality (NOT-OD-20-104). The United States fares worst among developed nations in preventing pregnancy-related deaths; over the past two decades, mortality rates doubled in the US while decreasing elsewhere. For every maternal death, >100 women experience severe maternal morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during delivery hospitalization. Striking disparities in severe maternal morbidity and mortality (SMMM) persist even though two-thirds of SMMM cases may be preventable. Non-Hispanic Black and low-income women have significantly higher rates of SMMM compared to their counterparts. Behavioral Health (BH) conditions such as suicide, drug overdose, homicide, and unintentional injury are among leading contributors to SMMM, yet these deaths are excluded from population-based pregnancy-related death statistics, likely leading to underestimates of SMMM. In addition to BH causes of SMMM, BH conditions may exacerbate SMMM from other causes. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and subsequent federal legislation affecting mental health and substance use disorder benefits, provided one of the largest expansions of behavioral health (BH) coverage in a generation by increasing coverage and extending federal parity protections to over 60 million Americans. Most health plans, including commercial, employer-based plans must cover BH care and cannot provide less generous BH coverage relative to medical/surgical care. Over half of pregnant women are privately insured, and improved coverage due to BH policy changes could affect their BH service receipt. The proposed study capitalizes on R01MH120124, which examines how federal BH policy changes affect outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine SMMM overall and among high-risk populations. It will use a large, economically, racially diverse national sample of enrollees in employer- based insurance, Optum, from 2005-2018. This proposed one-year study will use patient- and plan-level analyses of delivering women to examine associations of mandated federal BH policy changes with: 1) changes in SMMM in the perinatal period (e.g., 21 severe maternal morbidity indicators, overdose, suicidality, and death from any cause during pregnancy, delivery hospitalization, and up to one year postpartum; 2) changes in SMMM within high-risk subgroups. For each Aim 1 outcome, we will examine how changes vary: 1) for those with and without co-occurring PMAD and substance use disorders; 2) by race/ethnicity, 3) by income, 4) in states with strong vs. weak pre-existing parity laws, and 5) in plans subject to new parity laws vs. those not subject to the laws. Despite growing awareness of lethal consequences delivering women face, we know little about BH contributors to these outcomes. For NIH to effectively Implement a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE), we must not ignore the impact of BH conditions, treatments, and coverage policies.

这项研究直接回应特殊关注通知（NOSI）：NIH赠款的行政补品 添加或扩大针对孕产妇死亡率的研究（NOT-OD-20-104）。美国票价最差 在预防妊娠有关的死亡方面发展了国家；在过去的二十年中，死亡率增加了一倍 美国在其他地方减少。对于每一个孕产妇死亡，> 100名妇女都会经历严重的母亲 发病率，威胁生命的诊断或在分娩住院期间接受挽救生命的程序。 尽管三分之二，但仍存在严重的孕产妇发病率和死亡率（SMMM）的巨大差异（SMMM） SMMM案例可能是可以预防的。非西班牙裔黑人和低收入妇女的发生率明显更高 与同行相比，SMMM的行为健康（BH）条件，例如自杀，药物过量， 杀人罪和无意伤害是SMMM的主要贡献者，但这些死亡被排除在外 从基于人群的妊娠相关的死亡统计数据，可能导致SMMM低估。在 除了BH原因外，BH条件可能会加剧其他原因。 《 2008年的《心理健康平价与成瘾公平法》（MHPAEA）以及随后的联邦立法 影响心理健康和药物使用障碍的益处，提供了行为最大的扩展之一 一代人的卫生（BH）覆盖范围，通过增加覆盖范围并将联邦均等保护措施扩大到60多个 百万美国人。包括商业，基于雇主的商业计划在内的大多数健康计划都必须涵盖BH护理和 相对于医疗/手术护理，不能提供较少慷慨的BH覆盖范围。超过一半的孕妇是 私人保险和由于BH政策变更而改善的承保范围可能会影响其BH服务收据。 拟议的研究大写了R01MH120124，该研究研究了联邦BH政策变化如何影响 围产期情绪和焦虑症的结果（PMAD）。这项研究将整体检查SMMM 高风险人群。它将使用大型，经济上，种族多样化的全国参与者样本 基于2005 - 2018年的Optum保险。这项拟议的一年研究将使用患者和计划级分析 交付妇女以检查授权联邦BH政策变更的关联：1）SMMM的变化 在围产期（例如，21个严重的母体发病率指标，过量，自杀和死亡。 由于怀孕期间，住院和产后一年最多一年； 2）内部SMMM的变化 高风险亚组。对于每个目标1结果，我们将研究变化的变化：1） 同时出现的PMAD和药物使用障碍； 2）按种族/种族，3）收入，4）在有强度的州中。 预先存在的平价法和5）在遵守新的平等法律的计划中，而不受法律约束的计划。 尽管人们对赋予女性面临的致命后果的认识越来越多，但我们对BH的贡献者一无所知 这些结果。 NIH有效地实施孕产妇的健康和怀孕结果 每个人（改进），我们绝不能忽略BH条件，治疗和覆盖范围政策的影响。