Administrative Supplement to Policy Change and Women's Health

政策变化和妇女健康的行政补充

• 批准号: 10194963
• 负责人: Claire E Margerison
• 金额: $ 22.5万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-16 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10194963
• 关键词: Address; Administrative Supplement; Affordable Care Act; African American; Alaska Native; Alcohol or Other Drugs use; Caring; Cessation of life; Clinical; Conceptions; Contraceptive methods; Data; Death Records; Domestic Violence; Eligibility Determination; Ethnic Origin; Face; Fertility; Goals; Health; Health Insurance; Health Policy; Health Services Accessibility; Health behavior; Homicide; Hypertension; Improve Access; Income; Indigenous; Insurance; Insurance Coverage; Intervention; Knowledge; Low income; Measures; Medicaid; Medicaid eligibility; Mental Health; Methodology; Methods; Monitor; Native Americans; Not Hispanic or Latino; Outcome; Overdose; Parents; Perinatal; Pharmaceutical Preparations; Policies; Postpartum Period; Pregnancy; Pregnancy Rate; Privatization; Public Health; Race; Reproductive Health; Research; Resources; Risk; Risk Factors; Suicide; System; Testing; Vital Statistics; Woman; Women' s Health; depressive symptoms; health care service utilization; improved; interest; mortality; perinatal period; postpartum care; postpartum health; pregnancy associated death; racial and ethnic; racial and ethnic disparities; screening; unintended pregnancy; violence victimization

PROJECT SUMMARY The central goal of our parent R01 project, Policy Change and Women's Health (HDR01095951), is to examine the impact of Medicaid expansion, particularly under the Affordable Care Act (ACA), on preconception health, reproductive health behavior (e.g., contraception, unintended pregnancy, and fertility), and pregnancy health and outcomes. With this Supplement request, we propose to extend our inquiry to address the impact of Medicaid expansion on pregnancy-associated mortality and its determinants in the postpartum period. Prior to the ACA Medicaid expansions, many low-income women who qualified for Medicaid during pregnancy lacked health insurance coverage prior to conception and subsequently lost coverage 60 days after delivery. This discontinuity of insurance across the perinatal period may be a key determinant in pregnancy-associated mortality. The expansion of Medicaid to low income women regardless of pregnancy status offers an opportunity to examine whether increasing continuity of insurance prior to and after pregnancy improves postpartum health care utilization, mental health, and rates of pregnancy-associated mortality. Thus, we will extend Aim 1 of our Parent R01, which assesses the impact of Medicaid expansion on preconception health care utilization, health behavior, and health using Pregnancy Risk Monitoring System (PRAMS) 2012-2017 data to also assess postpartum continuity of insurance, health care utilization, and mental health. We will extend Aim 3 of our Parent R01, which examines the impact of Medicaid expansion on pregnancy health and outcomes using vital statistics data, to assess overall and cause-specific pregnancy-related mortality. Moreover, we will examine racial/ethnic inequities in the impact of Medicaid expansion on both determinants of and rates in pregnancy-associated mortality. Achieving these aims will expand research on one of the potential leading causes of pregnancy-associated mortality in the U.S.: discontinuous insurance during the perinatal period, particularly the cessation of Medicaid eligibility after 60 days postpartum. We will also identify how policy-level determinants impact racial/ethnic disparities in risk factors for and rates of pregnancy-associated mortality in the U.S.

项目概要 我们的母 R01 项目政策变革和妇女健康 (HDR01095951) 的中心目标是检查 医疗补助扩大的影响，特别是《平价医疗法案》(ACA) 下的医疗补助扩大对孕前健康的影响， 生殖健康行为（例如避孕、意外怀孕和生育）和妊娠健康 和结果。根据此补充请求，我们建议扩大调查范围，以解决以下问题的影响： 医疗补助扩大对妊娠相关死亡率及其产后决定因素的影响。之前 随着 ACA 医疗补助计划的扩展，许多在怀孕期间符合医疗补助资格的低收入妇女缺乏 受孕前的健康保险承保范围，随后在分娩后 60 天后失去承保范围。这 围产期保险的中断可能是妊娠相关疾病的一个关键决定因素 死亡。将医疗补助扩大到低收入女性，无论怀孕状况如何，都提供了 有机会检查怀孕前后增加保险的连续性是否会改善 产后保健利用、心理健康和妊娠相关死亡率。这样，我们将 扩展我们的父 R01 的目标 1，评估医疗补助扩展对孕前健康的影响 2012-2017 年护理利用率、健康行为和使用妊娠风险监测系统 (PRAMS) 的健康状况 数据还可以评估产后保险的连续性、医疗保健的利用和心理健康。我们将 扩展我们的父 R01 的目标 3，该目标检查医疗补助扩大对怀孕健康和 使用生命统计数据来评估总体和特定原因的妊娠相关死亡率。 此外，我们将研究医疗补助扩张对种族/民族不平等的两个决定因素的影响。 和妊娠相关死亡率。实现这些目标将扩大对其中一项潜力的研究 美国妊娠相关死亡的主要原因：围产期保险不连续 期间，特别是产后 60 天后停止医疗补助资格。我们还将确定如何 政策层面的决定因素影响妊娠相关风险因素和发生率的种族/民族差异 美国的死亡率