Hospital quality, Medicaid expansion, and racial/ethnic disparitiesin maternal mortality and morbidity

医院质量、医疗补助扩大以及孕产妇死亡率和发病率的种族/民族差异

• 批准号: 10654573
• 负责人: Nansi Boghossian
• 金额: $ 61.4万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-17 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654573
• 关键词: Accounting; Address; Adult; Area; Biometry; Birth Certificates; Bypass; California; Caring; Cities; Clinical; Data; Data Set; Discipline of obstetrics; Disparity; Economics; Eligibility Determination; Ethnic Origin; Florida; Geography; Health Policy; Health Services Research; Healthcare Systems; Hispanic; Hospitals; Incidence; Income; Individual; Insurance; Investigation; Link; Louisiana; Massachusetts; Maternal Mortality; Measures; Medicaid; Medical; Minority; Minority Women; Missouri; Morbidity - disease rate; Mothers; Natural experiment; Neonatology; New York City; Newborn Infant; Outcome; Patients; Pennsylvania; Perinatal Epidemiology; Play; Policies; Population; Pregnancy; Public Health; Quality of Care; Race; Records; Reporting; Research; Risk; Risk Adjustment; Role; Rural; Rural Population; Socioeconomic Status; South Carolina; Standardization; Structural Racism; Time; Transcend; Travel; Urban Hospitals; Urban Population; Variant; Very Low Birth Weight Infant; Vital Statistics; Washington; Woman; Work; adverse maternal outcomes; adverse outcome; black women; care providers; cost effective; design; disparities in morbidity; disparity reduction; effective intervention; ethnic difference; ethnic disparity; ethnic health disparity; experience; federal poverty level; health care delivery; health care disparity; improved; innovation; maternal morbidity; maternal outcome; racial difference; racial disparity; racial health disparity; racial minority; research study; rural area; safety net; severe maternal morbidity; sociodemographics; socioeconomics

Abstract: Racial and ethnic disparities in maternal adverse outcomes remain a significant public health problem. Studies conducted in New York City (NYC) hospitals have shown that minority women are more likely to deliver in low-quality hospitals and that they are also at a higher within-hospital risk of severe maternal morbidity (SMM) than white women, even after accounting for type of insurance. Although these studies represent important pointers in our understanding of SMM disparities, there are still many open questions about how quality of delivery hospitals drives the higher rates in adverse outcomes observed for minority women. First, it is unknown whether racial/ethnic differences in delivery hospital quality (between and within) exist in cities or regions other than NYC, especially in rural areas. Second, there is little information on the reasons for differences in where women of different racial/ethnic status deliver. Third, previous efforts examining racial disparities in healthcare delivery have mainly focused on individual-level factors overlooking the broader macro-level societal and structural conditions (e.g., structural racism) that may be at play. Finally, it is unknown how important policies such as Medicaid expansion have impacted obstetric hospital quality, especially minority- and rural-serving hospitals. Research studies investigating higher level factors that transcend individual-level factors to explain racial/ethnic disparities in maternal outcomes are urgently needed to design effective interventions. Thus, the proposed study will address the following: 1) Determine the contribution of delivery hospital quality to racial/ethnic disparities in maternal mortality and SMM; 2) Examine within-hospital racial/ethnic disparities in risk-adjusted maternal mortality and severe morbidity and identify whether these disparities are associated with types of medical insurance and broader societal and structural conditions; 3) Determine societal- and individual-level maternal factors associated with using versus bypassing high-quality hospitals; 4) Identify the impact of expanded Medicaid income eligibility to adults earning up to 138% federal poverty level on: (Aim 4a) hospital quality (especially safety-net and rural-serving hospitals); and (Aim 4b) the incidence of maternal mortality and SMM, either overall or by race/ethnicity and socioeconomic status. We will use birth certificate data linked to hospital discharge data and supplemented by other datasets from eight U.S. states from 2000-2019 to develop a risk-adjusted maternal mortality and SMM composite outcome which will allow us to rank hospitals. We will subsequently use hospital ranking to examine the contribution of hospital quality to racial/ethnic disparities. The aim on Medicaid expansion will make use of a natural experiment framework and difference-in-difference analysis resulting in comparing each state to itself, before and after Medicaid expansion. At the end of the study, we will have a better understanding of racial/ethnic disparities in the health care system among all mothers in eight states and will identify potential areas for improvement that can have profound implications on reducing disparities.

摘要：孕产妇不良后果的种族和种族差异仍然是重要的公共卫生 问题。在纽约市（NYC）医院进行的研究表明，少数妇女更有可能 在低品质的医院送货，并且它们的医院内风险较高 即使考虑到保险类型，发病率（SMM）也比白人妇女。虽然这些研究 在我们对SMM差异的理解中代表重要的指示，仍然有许多开放问题 关于送货医院的质量如何推动少数族裔观察到的不良后果的较高比率 女性。首先，尚不清楚分娩医院质量的种族/种族差异（内部和内部）是否存在 存在于纽约市以外的城市或地区，尤其是在农村地区。其次，关于 在不同种族/族裔身份不同的妇女提供差异的原因。第三，以前的努力 检查医疗保健交付中的种族差异主要集中于忽视的个人级别因素 可能正在发挥的更广泛的宏观社会和结构条件（例如结构性种族主义）。最后，它 尚不清楚医疗补助扩张等重要政策如何影响产科医院的质量， 特别是少数民族和农村服务医院。研究研究了更高级别因素的研究 迫切需要超越个人水平的因素来解释母亲的种族/种族差异 设计有效的干预措施。因此，拟议的研究将解决以下内容：1）确定 送达医院质量对孕产妇死亡和SMM种族/族裔差异的贡献； 2）检查 院内种族/族裔/种族差异在经过风险调整的孕产妇死亡率和严重的发病率中，并确定 这些差异是否与医疗保险类型以及更广泛的社会和结构性相关 状况; 3）确定与使用与绕过的社会和个人水平的母体因素 高质量的医院； 4）确定扩大的医疗补助收入资格对成年人的影响 138％的联邦贫困水平：（ AIM 4A）医院质量（尤其是安全网和农村服务医院）；和 （AIM 4B）总体或种族/民族和社会经济 地位。我们将使用链接到医院出院数据并补充其他数据集的出生证明数据 从2000年至2019年的美国八个州开始开发经风险调整的孕产妇死亡率和SMM综合 结果将使我们能够对医院进行排名。随后，我们将使用医院排名来检查 医院质量对种族/种族差异的贡献。医疗补助扩展的目的将利用 自然实验框架和差异差异分析导致每个状态与自身的比较， 医疗补助扩张之前和之后。在研究结束时，我们将对 八个州的所有母亲的医疗保健系统中的种族/种族差异，将确定潜力 改进的领域可能会对降低差异产生深远的影响。

项目成果

US Trends in Maternal Mortality by Racial and Ethnic Group.

美国按种族和民族划分的孕产妇死亡率趋势。

• DOI: 10.1001/jama.2023.17544
• 发表时间: 2023
• 期刊: JAMA
• 作者: Pecker,LydiaH;Boghossian,NansiS;Saade,George
• 通讯作者: Saade,George

Transfer Patterns of Very Low Birth Weight Infants for Convalescent Care.

极低出生体重婴儿恢复期护理的转移模式。

• DOI: 10.1542/peds.2021-054866
• 发表时间: 2022
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Boghossian,NansiS;Greenberg,LucyT;Edwards,ErikaM;Horbar,JeffreyD
• 通讯作者: Horbar,JeffreyD

Association of Sickle Cell Disease With Racial Disparities and Severe Maternal Morbidities in Black Individuals.

镰状细胞病与黑人种族差异和严重孕产妇发病率的关联。

• DOI: 10.1001/jamapediatrics.2023.1580
• 发表时间: 2023
• 期刊: JAMA pediatrics
• 影响因子: 26.1
• 作者: Boghossian,NansiS;Greenberg,LucyT;Saade,GeorgeR;Rogowski,Jeannette;Phibbs,CiaranS;Passarella,Molly;Buzas,JeffreyS;Lorch,ScottA
• 通讯作者: Lorch,ScottA

Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks' Gestation, 2009-2020.

2009-2020 年妊娠 30 周以下婴儿分娩医院新生儿重症监护资源趋势。

• DOI: 10.1001/jamanetworkopen.2023.12107
• 发表时间: 2023-05-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Boghossian, Nansi S.;Geraci, Marco;Phibbs, Ciaran S.;Lorch, Scott A.;Edwards, Erika M.;Horbar, Jeffrey D.
• 通讯作者: Horbar, Jeffrey D.

Changes in hospital quality at hospitals serving black and hispanic newborns below 30 weeks' gestation.

• DOI: 10.1038/s41372-021-01222-3
• 发表时间: 2022-03
• 期刊: Journal of perinatology : official journal of the California Perinatal Association
• 作者: Boghossian NS;Geraci M;Edwards EM;Horbar JD
• 通讯作者: Horbar JD