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: 10409775
• 负责人: Kara Zivin
• 金额: $ 40.77万
• 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 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409775
• 关键词: Address; Admission activity; Affect; American; Anxiety; Anxiety Disorders; Area; Awareness; Caring; Cesarean section; Child; Clinical; Data; Data Mart; Detection; Diagnosis; Disease; Economics; Emergency department visit; Enrollment; Ethnic Origin; Expenditure; Family; Feeling suicidal; Funding; Future; Generations; Health Benefit; Health Expenditures; Health Insurance; Health Legislation; Health Personnel; Health Policy; Health Services; Health Services Research; Healthcare; Helping to End Addiction Long-term; Income; Infant; Inpatients; Insurance; Insurance Coverage; Intervention; Investigation; Laws; Link; Maternal Health; Maternal Mortality; Medical; Mental Depression; Mental Health; Mental Health Services; Mood Disorders; Mothers; National Institute of Mental Health; Natural experiment; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Operative Surgical Procedures; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Pain; Patients; Pattern; Perinatal; Perinatal Care; Persons; Pharmaceutical Preparations; Policies; Population; Population trends; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Provider; Psychotherapy; Public Health; Race; Research; Respiratory distress; Sampling; Self-Injurious Behavior; Speed; Statutes and Laws; Subgroup; Substance Use Disorder; Suicide; Suicide attempt; Treatment outcome; United States National Institutes of Health; Visit; Woman; Work; addiction; adverse birth outcomes; adverse outcome; base; behavioral health; chronic pain; chronic pain management; cost; cost outcomes; economic impact; economic outcome; experience; health care delivery; health plan; high risk population; hospital readmission; improved; infant outcome; innovation; interest; intergenerational; maternal outcome; negative affect; neonatal health; opioid epidemic; opioid misuse; opioid use; opioid use disorder; parity; perinatal mental health; perinatal outcomes; perinatal period; perinatal women; pregnancy related death; prescription opioid; self diagnosis; severe maternal morbidity; suicidal risk; 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 NIMH 特别关注通知：帮助戒除长期成瘾 (HEAL) 补充剂，以改善受阿片类药物危机影响的人群常见并发疾病和自杀风险的治疗和管理 (NOT-MH- 20-025）与总体人口趋势相一致的是，在分娩前后一年内未经治疗的阿片类药物使用障碍（OUD）导致孕产妇和婴儿结局不佳，包括与妊娠相关的过量用药、自杀和分娩。新生儿戒断综合征（NAS）。如果阿片类药物治疗的疼痛得不到有效治疗，接受慢性疼痛治疗的围产期妇女也会经历类似的不良后果。 2008 年《心理健康平等和成瘾公平法案》(MHPAEA) 以及随后影响心理健康和物质使用障碍福利的联邦立法，通过增加覆盖范围和扩大联邦平等，提供了一代人中最大规模的行为健康 (BH) 覆盖范围之一大多数健康计划，包括基于雇主的商业计划，必须涵盖 BH 护理，并且不能提供比医疗/手术护理更宽松的 BH 保险，超过一半的孕妇有私人保险，并且覆盖范围有所改善。由于 BH 政策的变化可能会影响他们的 BH 服务收据。 拟议的为期两年的研究利用了 R01 MH120124，该研究探讨了联邦 BH 政策的变化如何影响围产期情绪和焦虑障碍 (PMAD) 的结果。这项研究将调查分娩妇女中阿片类药物和疼痛相关的结果。使用 Optum Clinformatics 数据集市和相关母婴数据加入基于雇主的保险的女性样本 我们将使用为女性提供阿片类药物处方的患者水平分析来检查强制联邦的关联。 BH 政策的变化包括：1) 阿片类药物处方、OUD、MOUD、围产期慢性疼痛和自杀倾向的变化；2) 与分娩相关的孕产妇结局的变化，包括剖腹产和严重孕产妇发病率，以及婴儿结局，包括早产、 NAS 新生儿重症监护病房 (NICU) 入院、呼吸窘迫以及 3) 围产期母婴利用率和支出的变化 对于每个目标，我们将研究变化的差异：1) 的变化。那些同时存在和不存在 PMAD 的州；2) 现有平等法较强的州与较弱的州；3) 受新平等法约束的计划与不受该法律约束的计划。 尽管人们越来越认识到围产期阿片类药物使用和慢性疼痛的负面后果，但我们对 BH 政策对相关围产期结局的影响知之甚少，因为围产期阿片类药物使用和未经治疗的 OUD 给母亲和婴儿带来高昂的代际成本，尤其是那些患有 OUD 的母亲和婴儿。 PMAD，这项创新的大规模调查将为未来的政策制定和临床干预工作提供必要的证据，并可能影响这一昂贵的高风险人群的与分娩相关的以及下游的临床和经济结果。 这项研究是 NIH 帮助结束成瘾长期 (HEAL) 计划的一部分，该计划旨在加快解决国家阿片类药物公共卫生危机的科学解决方案。 NIH HEAL 计划支持 NIH 的研究，以改善阿片类药物滥用和成瘾的治疗。

项目成果

Perinatal insurance coverage and behavioural health-related maternal mortality.

• DOI: 10.1080/09540261.2021.1903843
• 发表时间: 2021-09
• 期刊: INTERNATIONAL REVIEW OF PSYCHIATRY
• 影响因子: 2.8
• 作者: Admon, Lindsay K.;Zivin, Kara;Kozhimannil, Katy B.
• 通讯作者: Kozhimannil, Katy B.

Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders.

• DOI: 10.1377/hlthaff.2021.00780
• 发表时间: 2021-10
• 期刊: HEALTH AFFAIRS
• 影响因子: 9.7
• 作者: Zochowski, Melissa K.;Kolenic, Giselle E.;Zivin, Kara;Tilea, Anca;Admon, Lindsay K.;Hall, Stephanie, V;Advincula, Agatha;Dalton, Vanessa K.
• 通讯作者: Dalton, Vanessa K.