A comprehensive assessment of maternal health and pregnancy outcomes among women veterans

女退伍军人孕产妇健康和妊娠结局的综合评估

• 批准号: 10599236
• 负责人: CIARAN S. PHIBBS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599236
• 关键词: Address; Admission activity; Affect; Age; Age Distribution; Area; Back; Birth; California; Caring; Cesarean section; Characteristics; Communities; Complication; Data; Diffusion; Discipline of obstetrics; Disparity; Enrollment; Equity; Ethnic Origin; Evaluation; Feedback; General Population; Geography; Growth; Health; Healthcare; High-Risk Pregnancy; Hospitals; Individual; Infant; International; Learning; Life; Link; Literature; Maternal Age; Maternal Health; Maternal Mortality; Maternal complication; Medicaid; Mental Health; Mental Health Services; Methodology; Methods; Military Personnel; Neonatal; Neonatal Mortality; Newborn Infant; Outcome; Patients; Perinatal Care; Policies; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prenatal care; Process; Provider; Quality Indicator; Race; Records; Regression Analysis; Reproductive Health; Research; Research Priority; Risk; Risk Factors; Rural; Techniques; Time; Time trend; Translating; Translations; Veterans; Woman; Women' s Health Services; Work; care coordination; experience; health disparity; high risk; improved; infant outcome; innovation; maternal outcome; maternal risk; mortality; neonatal outcome; pregnant; premature; racial disparity; racial diversity; rapid growth; reproductive; rural disparities; rurality; severe maternal morbidity; trend; urban disparity; virtual

Background: Women are a growing share of the VA population, especially among younger Veterans. To date there hasn’t been a comprehensive assessment of pregnancy outcomes among women Veterans, which is needed, especially given that Veterans have higher pregnancy risk profiles than the general population. Significance: Given the growing share of women Veterans, their increased pregnancy risk, and known U.S. racial and geographic maternal health disparities, VA needs to better understand the provision and outcomes of pregnancy care to implement policies to optimize pregnancy outcomes for Veterans. Findings will facilitate the VA Office of Women’s Health Services (WHS) efforts to improve pregnancy care and outcomes. Innovation and Impact: Existing state of the art methods will be innovatively applied to examine national VA and state Medicaid records in parallel to comprehensively assess VA maternity care. This project is the first to rigorously compare VA pregnancy outcomes with those in the general population at a national level. Specific Aims: Aim 1. This aim has two parts, of which the first is purely descriptive: We will describe a wide range of key maternal outcomes, examining trends and changes over time (with respect to key VA policy changes) for all pregnancies where the VA provided pregnancy care (purchased). Key maternal outcomes will include cesarean deliveries, pregnancy complications and severe maternal morbidity (SMM), a CDC defined set of serious life-threatening maternal complications. We will also describe a broad range of maternal risk factors (individual health factors, and systemic factors of race and geography) and process outcomes including use of prenatal care, VA mental healthcare, and post-partum reintegration to VA care. We will also examine if Veterans with known risk-factors deliver at settings appropriate for their risk levels, as outcomes are demonstrably worse when high-risk deliveries occur in sub-optimal settings. Concurrently we will assess key infant outcomes (e.g., mortality, prematurity, and unexpected NICU admission—i.e. in non-preterm infants). The final part of Aim 1 will use regression analyses to examine the impacts of VA policy changes on key outcomes, while also analyzing the extent of racial/ethnic and urban/rural disparities in outcomes. Aim 2: Repeat, in parallel, the Aim 1 descriptive analyses, for deliveries to VA-enrolled Veterans who do NOT use VA maternity benefits, but instead use Medicaid. We will assess how these Veterans differ in characteristics and maternal outcomes. Since they have chosen not to have VA cover their delivery, we will also assess their use of VA care in the years prior to and after delivery to determine if opting for non-VA pregnancy care was a temporary or lasting healthcare shift away from VA. Aim 3: Compare key outcomes (e.g., complication rates and SMM) of VA-covered deliveries and of Medicaid-covered Veterans’ deliveries with those in the general population. Examine if known disparities racial/ethnic and urban/rural in birth outcomes are more/less pronounced in VA or Medicaid covered Veterans. Methodology: Established CDC methods will be used to search VA administrative records, including purchased care, to identify all enrolled women Veterans who received pregnancy care, extending back to 2000, when VA first covered pregnancy, through 2021. These data will be supplemented by all years of Medicaid data that are available. In addition to descriptive analysis, regression analyses will be used to adjust for known risk factors and moderators to examine a wide range of pregnancy outcomes. Causal inference techniques will be used to analyze the effect of VA and other policies on key outcomes. The study team is led by internationally recognized experts in the evaluation of perinatal care and they have all of the needed expertise to conduct appropriate analyses and effectively disseminate the findings. Next Steps/Implementation: We work closely WHS to share results and tailor analyses to their information needs. WHS can directly implement change via directives to maternity care coordinators at all VA facilities.

背景：女性在退伍军人管理局人口中所占的比例越来越大，尤其是在年轻的退伍军人中。 目前还没有对女性退伍军人的妊娠结局进行全面评估， 需要，特别是考虑到退伍军人的怀孕风险高于普通人群。 意义：鉴于女性退伍军人的比例不断增加，她们怀孕的风险也随之增加，而且美国已知的女性退伍军人比例也不断增加。 种族和地理孕产妇健康差异，退伍军人事务部需要更好地了解提供和结果 怀孕护理实施政策以优化退伍军人的怀孕结果将有助于。 退伍军人事务部妇女健康服务办公室 (WHS) 致力于改善妊娠护理和结果。 创新和影响：现有最先进的方法将被创新地应用于检查国家 VA 并同时列出医疗补助记录，以全面评估 VA 产妇护理 该项目是第一个项目。 严格比较 VA 的妊娠结局与全国普通人群的妊娠结局。 具体目标： 目标 1。该目标有两个部分，其中第一个部分纯粹是描述性的：我们将描述一个广泛的 一系列关键的产妇结局，检查随时间变化的趋势和变化（关于关键的 VA 政策） VA 提供妊娠护理（购买）的所有妊娠将发生变化）。 CDC 定义，包括剖腹产、妊娠并发症和严重孕产妇发病率 (SMM) 我们还将描述一系列严重危及生命的孕产妇并发症。 因素（个人健康因素以及种族和地理的系统因素）和过程结果，包括 我们还将检查是否使用产前护理、VA 心理保健以及产后重新融入 VA 护理。 具有已知风险因素的退伍军人在适合其风险水平的环境中分娩，因为结果是 当高风险分娩发生在次优环境中时，情况显然会更糟，同时我们将评估关键因素。 婴儿结局（例如死亡率、早产和意外入住 NICU，即非早产儿）。 目标 1 的最后一部分将使用回归分析来检验 VA 政策变化对关键因素的影响。 结果，同时还分析结果中种族/民族和城市/农村差异的程度。 目标 2：同时重复目标 1 描述性分析，向 VA 注册的退伍军人交付，这些退伍军人 不要使用退伍军人管理局的生育福利，而是使用医疗补助。我们将评估这些退伍军人在哪些方面有何不同。 由于她们选择不让 VA 承担她们的分娩费用，我们将 还评估他们在分娩前后几年对 VA 护理的使用情况，以确定是否选择非 VA 护理 怀孕护理是从 VA 暂时或持久的医疗保健转变。 目标 3：比较 VA 承保的分娩和 VA 承保的分娩的主要结果（例如，并发症发生率和 SMM） 检查医疗补助覆盖的退伍军人与普通人群的分娩情况是否存在已知差异。 在退伍军人管理局或医疗补助覆盖的退伍军人中，种族/民族和城市/农村的出生结果或多或少明显。 方法：已建立的 CDC 方法将用于搜索 VA 行政记录，包括 购买护理，以确定所有接受怀孕护理的登记女性退伍军人，可追溯到 2000 年，VA 首次涵盖怀孕，一直持续到 2021 年。这些数据将由所有年份的数据进行补充 除了描述性分析之外，还将使用回归分析来进行调整。 针对已知的风险因素和调节因素来检查各种妊娠结果。 该研究团队将使用技术来分析 VA 和其他政策对关键结果的影响。 由国际公认的围产期护理评估专家负责，他们拥有所有所需的 进行适当分析并有效传播研究结果的专业知识。 后续步骤/实施：我们密切合作，分享结果并根据他们的信息进行定制分析 WHS 可以通过向所有 VA 机构的产妇护理协调员发出指令来直接实施变革。