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: 10197811
• 负责人: Kara Zivin
• 金额: $ 70.72万
• 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/10197811
• 关键词: Address; Affect; American; Anxiety; Anxiety Disorders; Area; Caring; Cesarean section; Child; Clinical; Cost Sharing; Data; Data Mart; Detection; Diagnosis; Disease; Economics; Emergency department visit; Enrollment; Ethnic Origin; Ethnic group; Expenditure; Family; Feeling suicidal; Funding; Future; Generations; Health Benefit; Health Expenditures; Health Insurance; Health Legislation; Health Personnel; Health Policy; Health Services Research; Healthcare; Income; Inpatients; Insurance; Insurance Coverage; Intervention; Investigation; Laws; Maternal Health; Maternal Mortality; Medical; Mental Depression; Mental Health; Mental Health Services; Mood Disorders; Mothers; National Institute of Mental Health; Natural experiment; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pattern; Perinatal; Perinatal Care; Pharmaceutical Preparations; Policies; Population; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Provider; Psychotherapy; Race; Research; Sampling; Self-Injurious Behavior; Statutes and Laws; Subgroup; Suicide; Suicide attempt; Treatment outcome; Visit; Woman; Work; addiction; adverse birth outcomes; base; cost; economic impact; economic outcome; health care delivery; health plan; hospital readmission; improved; innovation; intergenerational; negative affect; neonatal health; parity; perinatal mental health; perinatal period; pregnancy related death; prevent; self diagnosis; severe maternal morbidity; treatment of anxiety disorders

This study directly responds to the NIMH Notice of Special Interest: Helping to end addiction long-term (HEAL) supplements to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis (NOT-MH-20-025). Paralleling overall population trends, opioid use has escalated among delivering women. Untreated opioid use disorder (OUD) during the year before and after delivery leads to poor maternal and infant outcomes, including pregnancy-related overdose, suicide, and neonatal abstinence syndrome (NAS). Perinatal women treated for chronic pain my experience similar adverse outcomes if their opioid-managed pain is not handled effectively. 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 two-year study capitalizes on R01 MH120124, which examines how federal BH policy changes influence outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine opioid and pain- related outcomes among delivering women. It will use a large national sample of women enrolled in employer- based insurance using Optum Clinformatics Data Mart with linked mother-infant data. We will use patient-level analyses of delivering women with opioid prescriptions to examine associations of mandated federal BH policy changes with: 1) changes in opioid prescriptions, OUD, MOUD, chronic pain, and suicidality in the perinatal period; 2) changes in delivery-related maternal outcomes including caesarean delivery and severe maternal morbidity, and infant outcomes including preterm birth, NAS neonatal intensive care unit (NICU) admission, respiratory distress and 3) changes in maternal and infant utilization and expenditures in the perinatal period. For each aim, we will examine how changes vary: 1) for those with and without co-occurring PMAD; 2) in states with strong compared to weak pre-existing parity laws, and 3) in plans subject to new parity laws compared to those exempted from the laws. Despite growing awareness of negative consequences of perinatal opioid use and chronic pain, we know little about impacts of BH policies on related perinatal outcomes. Given high, inter-generational costs for mother and baby of perinatal opioid use and untreated OUD, especially among those with PMAD, this innovative, large-scale investigation will provide evidence necessary for future policymaking and clinical intervention efforts, and could influence delivery-related and downstream clinical and economic outcomes for this costly, high-risk population. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.

这项研究直接响应了NIMH特别兴趣通知：帮助结束成瘾的长期（治愈）补充剂，以改善受阿片类药物危机影响的人们（非MH-20-025）的人们对常见的同时发生条件和自杀风险的治疗和自杀风险。在交付妇女中，阿片类药物的使用平均趋势与整体人口趋势升级。在分娩前后，未经治疗的阿片类药物使用障碍（OUD）导致较差的母子和婴儿结局，包括与妊娠有关的过量药物，自杀和新生儿的禁欲综合征（NAS）。如果无法有效处理因阿片类药物管理的疼痛而接受的慢性疼痛治疗的围产期妇女，我的经历类似的不良后果。 《 2008年的《心理健康平价与成瘾公平法》（MHPAEA）以及随后影响精神健康和药物使用障碍益处的联邦立法，这是行为健康（BH）的最大扩张之一，这是一代人的覆盖范围，通过增加覆盖范围并扩展到超过6000万美国人的联邦平价保护。包括商业，基于雇主的计划在内的大多数健康计划都必须涵盖BH护理，并且相对于医疗/手术护理，不能提供更少的BH覆盖范围。超过一半的孕妇是私人保险的，由于BH政策的变化而造成的覆盖范围的改善可能会影响其BH服务收据。 拟议的为期两年的研究将资本利用R01 MH120124，该研究研究了联邦BH政策如何改变围产期情绪和焦虑症的结果（PMAD）。这项研究将检查分娩妇女的阿片类药物和疼痛相关的结果。它将使用与链接的母亲数据一起使用Optum Clinformatics Data Mart参加基于员工保险的全国妇女样本。我们将使用患者级分析的分析，以交付有OIOID处方的妇女来检查授权的联邦BH政策变化的关联：1）围产期期间Oioid处方，OUD，MOUD，慢性疼痛和自杀性的变化； 2）与分娩相关的孕产妇结局的变化，包括剖腹产和严重的孕产妇发病率，以及婴儿的结局，包括早产，NAS新生儿重症监护病房（NICU）入院，呼吸窘迫和3）孕产妇利用和婴儿利用率和支出的变化。对于每个目标，我们将检查变化的变化：1）对于有和没有同时发生PMAD的人； 2）与较弱的均等法律相比，与违反法律的国家相比，在遵守新的平等法律的计划中，在遵守新的平等法律的计划中，3）在计划中。 尽管对围产期阿片类药物使用和慢性疼痛的负面后果的认识日益认识，但我们对BH政策对相关围产期结局的影响知之甚少。鉴于围产期阿片类药物使用和未经处理的OUD的母亲和婴儿的高代代成本，尤其是在PMAD的人中，这项创新的大规模投资将为未来的决策和临床干预工作提供必要的证据，并可能影响交付相关，下游和下游的临床和经济效果，以实现这一昂贵，高风险的人群。 这项研究是NIH的一部分，有助于长期（HEL）倡议结束成瘾，以加快对国家阿片类药物公共卫生危机的科学解决方案。 NIH Heal Heal Initiative Bolsters跨NIH的研究，以改善阿片类药物滥用和成瘾的治疗方法。