Multi-level factors affecting postpartum sterilization

影响产后绝育的多层次因素

基本信息

批准号：
10360685
负责人：
Kavita Shah Arora
金额：
$ 48.25万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-05 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10360685
关键词：
Achievement Advocate Affect Alabama Attitude Belief Birth California Clinical Complex Consent Forms Contraceptive Usage Contraceptive methods Data Databases Discipline of obstetrics Ensure Equilibrium Excision Female Sterilization Geography Goals Health Policy High Risk Woman Hospitals Individual Infant Health Institution Insurance Interview Knowledge Lead Literature Low Birth Weight Infant Maternal Health Medicaid Medical center Methods Mission Modeling Operating Rooms Outcome Paternalism Patients Pattern Physicians Policies Policy Developments Population Postpartum Period Postpartum Women Pre-Eclampsia Pregnancy Interval Premature Birth Prenatal care Privatization Process Provider Proxy Public Health Recording of previous events Reproductive Health Research Risk Route Sampling San Francisco Site State Hospitals Sterilization Structure Surveys Testing United States United States National Institutes of Health Universities Vulnerable Populations Woman Work clinical care cohort design disparity reduction effective intervention evidence base experience federal policy health disparity improved individual patient infant morbidity/mortality innovation insight low socioeconomic status maternal morbidity patient oriented patient population policy recommendation postpartum contraception preference pregnant provider factors social unintended pregnancy women of color

项目摘要

Female sterilization, the second most commonly used contraceptive method in the United States, is commonly performed during the postpartum period. However, women with Medicaid insurance are half as likely to obtain a desired postpartum sterilization as those with private insurance. Compounding this disparity, women of color with Medicaid insurance are less likely to achieve sterilization fulfillment compared to white women with Medicaid insurance. Sterilization non-fulfillment puts women at high risk of subsequent unintended pregnancy with a short interpregnancy interval and the associated risks to maternal and infant health. There are significant policy barriers to equitable postpartum sterilization that impact those with Medicaid but not private insurance. However, the federal Medicaid policy (including specific consent form and subsequent thirty- day waiting period) was established in 1976 due to coerced sterilizations on women of color and low socioeconomic status. Therefore, sensitive consideration of the complex social and cultural backdrop is required to balance protection of a vulnerable population with the unintended consequence of disparities in sterilization fulfillment. Furthermore, barriers at the patient, provider, and hospital level have also been noted, though it is unclear the extent to which these barriers interact. Advocating for the complete removal of the Medicaid sterilization process, then, ignores both the complex history as well as the additional, non-policy barriers to equitable postpartum sterilization. The overall objective for this proposal is to determine the discrete barriers at various levels of analysis (patient, provider, hospital, and policy). The central hypothesis is that the layering of barriers individually and collectively contributes to disparities in postpartum sterilization fulfillment for the Medicaid population. The rationale for the project is that identifying and understanding potential barriers is the critical next step to eradicating the disparities surrounding postpartum sterilization. Guided by strong preliminary data, this hypothesis will be tested through an explanatory sequential mixed methods design by pursuing three specific aims: 1) Model the association between Medicaid insurance and sterilization fulfillment after adjusting for clinical and demographic differences in a pooled multi-institution sample (patient- and policy- level barriers aim); 2) Identify the attitudes, beliefs, and practices of postpartum women and their obstetricians regarding postpartum sterilization (patient-, provider-, hospital-, and policy-level barriers aim); 3) Assess the impact of hospital and state policy barriers on postpartum sterilization (hospital- and policy-level barriers aim). The approach is innovative because it departs from the status quo by shifting focus away from studying barriers individually and toward the identification and assessment of various layers of barriers. This contribution will be significant because it is expected to inform an evidence-based and patient-centered health policy to eradicate health disparities and improve clinical outcomes due to sterilization non-fulfillment and resultant unintended pregnancies.

女性绝育是美国第二常用的避孕方法通常在产后期间进行。然而，拥有医疗补助保险的女性比例只有一半可能像拥有私人保险的人一样获得理想的产后绝育。加剧这种差距，与白人相比，拥有医疗补助保险的有色人种女性实现绝育的可能性较小拥有医疗补助保险的女性。不执行绝育手术会使女性面临随后发生意外的高风险妊娠间隔短的妊娠及其对母婴健康的相关风险。那里是公平产后绝育的重大政策障碍，影响那些享受医疗补助的人，但不影响私人保险。然而，联邦医疗补助政策（包括具体同意书和随后的三十- 日等待期）于 1976 年设立，原因是对有色人种和低等女性进行强制绝育。社会经济地位。因此，对复杂的社会文化背景的敏感考虑是需要平衡对弱势群体的保护与不平等造成的意外后果灭菌履行。此外，还注意到患者、提供者和医院层面的障碍，尽管尚不清楚这些障碍相互作用的程度。主张彻底废除因此，医疗补助灭菌过程忽略了复杂的历史以及额外的非政策性因素。公平产后绝育的障碍。该提案的总体目标是确定离散各个分析层面（患者、提供者、医院和政策）的障碍。中心假设是单独和集体的障碍分层导致产后绝育实施方面的差异对于医疗补助人口。该项目的基本原理是识别和理解潜在的障碍是消除产后绝育差异的关键下一步。强者引导初步数据，该假设将通过解释性顺序混合方法设计进行检验追求三个具体目标：1）建立医疗补助保险与绝育履行之间的关联模型在调整多机构汇总样本（患者和政策）中的临床和人口统计差异后水平障碍目标）； 2) 确定产后妇女及其产科医生的态度、信仰和做法关于产后绝育（患者、提供者、医院和政策层面的障碍目标）； 3）评估医院和国家政策障碍对产后绝育的影响（医院和政策层面的障碍目标）。这种方法是创新的，因为它通过将焦点从学习上转移而脱离了现状单独的障碍以及识别和评估各个层次的障碍。这个贡献将会很重要，因为预计它将为基于证据和以患者为中心的卫生政策提供信息消除由于灭菌未履行和由此产生的健康差异并改善临床结果意外怀孕。