Medicaid Expansion and Maternal Health in Racial and Ethnic Minority Women

少数族裔妇女的医疗补助扩展和孕产妇健康

基本信息

批准号：
10283253
负责人：
Jean R Guglielminotti
金额：
$ 20.25万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10283253
关键词：
Absence of pain sensation Admission activity Affect Affordable Care Act Anesthesia procedures Birth Birth Certificates Blood Transfusion Caring Censuses Centers for Disease Control and Prevention (U.S.)Certification Cesarean section Characteristics Childbirth Data Discipline of obstetrics District of Columbia Effectiveness Eligibility Determination Ensure General Anesthesia Goals Health Policy Hemorrhage Hemostatic Agents Hospitals Hysterectomy Income Information Systems Intensive Care Units Intervention Labor Pain Life Live Birth Maternal Health Medicaid Methods Morbidity - disease rate Not Hispanic or Latino Obstetrical Anesthesia Pain Pain management Pathway interactions Patients Perinatal Postpartum Hemorrhage Pregnancy Pregnant Women Prenatal care Research Project Grants Risk Spinal System Techniques Testing Uninsured United States Vaginal delivery procedure Vital Statistics Woman base disparity reduction effectiveness evaluation ethnic minority population evidence base experience improved intrapartum maternal morbidity maternal outcome mortality population health racial and ethnic disparities racial minority severe maternal morbidity

项目摘要

The broad long-term objective of the proposed research project is to ensure equitable access to safe and quality maternal care. Compared with non-Hispanic White women, racial and ethnic minority women are at significantly increased risks of experiencing severe pain and life-threatening complications during childbirth. Reducing racial and ethnic disparities in peripartum pain management and severe maternal morbidity is a national priority. Neuraxial analgesia (i.e., epidural or spinal analgesia) is the most effective technique to relieve labor pain, and it is associated with a reduced risk of severe obstetric hemorrhage. In the United States, severe obstetric hemorrhage disproportionately affects racial and ethnic minority women and is the leading cause of preventable maternal morbidity, peripartum maternal blood transfusion, hemostatic hysterectomy, and intensive care unit admission. However, labor neuraxial analgesia is underutilized in uninsured racial and ethnic minority women. Increasing access and utilization of labor neuraxial analgesia in uninsured racial and ethnic minority women could help reduce peripartum disparities in pain management and severe maternal morbidity. The 2014 Medicaid expansion under the Affordable Care Act has decreased the proportion of uninsured pregnant women and may have been associated with increased utilization of labor neuraxial analgesia and decreased risk of severe maternal morbidity. The proposed research project aims to assess in racial and ethnic minority women: 1) the association between labor neuraxial analgesia and the risks of 1a) peripartum maternal blood transfusion or hemostatic hysterectomy, and 1b) intensive care unit admission; and 2) the effectiveness of the 2014 Medicaid expansion under the Affordable Care Act in 2a) increasing labor neuraxial analgesia utilization, and 2b) reducing the risk of severe maternal morbidity. These specific aims will be achieved by analyzing birth certificate data from 2010 to 2018 from the National Vital Statistics System of the Centers for Disease Control and Prevention. This data system is a census of US births in the 50 states and the District of Columbia, based on the 2003 revised US Standard Certificate of Live Birth. Results of this project could provide scientific evidence for evaluating the Affordable Care Act and for informing healthcare policy to reduce racial and ethnic disparities in maternal health.

拟议的研究项目的广泛长期目标是确保公平获得安全和优质的产妇护理。与非西班牙裔白人妇女相比，种族和少数民族妇女处于在分娩过程中，遭受剧烈疼痛和威胁生命的并发症的风险显着增加。减少周围疼痛管理和严重母亲发病率的种族和种族差异是一种国家优先。神经镇痛（即硬膜外或脊髓镇痛）是最有效的技术缓解劳动疼痛，这与严重产科出血的风险降低有关。在美国，严重的产科出血不成比例地影响种族和少数民族妇女，是领导者可预防的孕产妇发病率，腹膜孕产妇输血，止血子宫切除术和重症监护病房入场。但是，在没有保险的种族中，劳动神经镇痛不足少数民族妇女。在没有保险的种族和少数民族妇女可以帮助减少疼痛管理和严重的母亲的周围差异发病率。根据《平价医疗法案》 2014年的医疗补助扩张已减少未投保的孕妇，可能与劳动神经利用率增加有关镇痛和降低严重孕产妇发病率的风险。拟议的研究项目旨在评估种族和少数民族妇女：1）协会在劳动神经镇痛和1a的风险之间子宫切除术和1B）重症监护病房入院； 2）2014年医疗补助扩展的有效性根据2A的《平价医疗法》）增加了劳动神经镇痛的利用，并降低风险严重的孕产妇发病率。这些具体目标将通过分析2010年的出生证书数据来实现到2018年，来自疾病控制与预防中心国家生命统计系统。这个数据根据2003年修订的美国，系统是美国50个州和哥伦比亚特区的美国诞生的人口普查。现场出生标准证书。该项目的结果可以提供科学证据来评估负担得起的护理法案，并告知医疗保健政策，以减少母亲的种族和种族差异健康。