Impact of Medicaid Postpartum Coverage Extension and Mandated Postpartum Depression Screening on Care for Gestational Diabetes and Pregnancy-Induced Hypertension

医疗补助产后覆盖​​范围扩大和强制性产后抑郁症筛查对妊娠期糖尿病和妊娠高血压综合征护理的影响

• 批准号: 10749378
• 负责人: LIZHENG SHI
• 金额: $ 65.41万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749378
• 关键词: Adopted; Affect; American; Antidepressive Agents; Birth; Blood Glucose; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Collaborations; Complex; Complications of Diabetes Mellitus; Cost Analysis; Cost Effectiveness Analysis; Data; Depression screen; Diabetes Mellitus; Diagnosis; Disparity; Eclampsia; Effectiveness; Electronic Health Record; Equity; Evaluation; Funding; Future; Gestational Diabetes; Goals; Health; Health Disparities Research; Health Personnel; Health Policy; Health behavior and outcomes; Health system; Healthcare; Hypertension; Individual; Kidney Diseases; Life; Link; Louisiana; Maternal Health; Maternal health equity; Measures; Medicaid; Mental Health; Mental disorders; Mississippi; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Measure; Patients; Persons; Policies; Policy Analysis; Postnatal Care; Postpartum Depression; Postpartum Period; Pre-Eclampsia; Pregnancy; Preventive service; Provider; Psyche structure; Recommendation; Risk; Risk Factors; Structure; Target Populations; United States; Vulnerable Populations; beneficiary; cardiovascular disorder risk; community based participatory research; contextual factors; cost effectiveness; cost estimate; effectiveness evaluation; effectiveness measure; empowerment; ethnic minority; experience; follow-up; glucose monitor; health care delivery; health care service utilization; health disparity; health equity; health inequalities; high risk; implementation strategy; improved; marginalization; outcome disparities; patient engagement; patient oriented; postpartum care; postpartum health; pregnancy hypertension; racial minority; scale up; screening; social; socioeconomic disadvantage; synergism

Abstract Both gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) affect pregnancy, birth outcomes, and postpartum care. They are independent risk factors for diabetes mellitus (T2DM), hypertension (HTN), and mental health conditions such as postpartum depression (PPD). Despite recommendations that postpartum care should include blood pressure (BP), blood glucose (BG) monitoring, and PPD screening, current postpartum care practices have low screening rates, especially among Medicaid beneficiaries. While Medicaid covers nearly half of deliveries in the United States, many birthing people lose coverage 60 days after birth. The American Rescue Plan Act of 2021 provided states with federal funding to extend postpartum coverage up to 12 months – Louisiana has done so while Mississippi has not. Additionally, on August 1, 2022, Louisiana enacted a statewide mandate requiring providers of postnatal care to screen for PPD and related mental health disorders. Using our collaboration with the National Birth Equity Collaborative and combined expertise, we propose to evaluate the effects of the Medicaid postpartum extension (MPE) and PPD screening mandate on screening behaviors, health outcomes, and patient experiences in Louisiana (LA) compared to Mississippi (MS) over three periods (early 2022-2023, middle 2024-2025, and late 2026-2027). We will link electronic health records and Medicaid claims data in Louisiana and Mississippi, allowing us to track screening and follow-up care even after birthing people lose Medicaid coverage. The primary effectiveness measure will be a 3-month composite screening rate for BP, BG, and PPD. Secondary measures include individual screening rates, diagnoses, and management of T2DM, HTN, and PPD. It is also critical to understand contextual factors and health inequities that contribute to disparities in postpartum care and to estimate the cost-effectiveness of these policies. The overall goal is to evaluate effective implementation strategies that aim to improve maternal postpartum health in Medicaid beneficiaries with GDM or PIH. To achieve this goal, the study will have three specific aims. First, we will examine the effectiveness of Louisiana’s MPE and PPD screening mandate on the rates of BG and BP monitoring, PPD screening, rates of T2DM, HTN, and PPD diagnoses, T2DM, HTN and PPD management, health disparities, and health care utilization, as compared to counterparts in Mississippi. The second aim will be to examine the cost-effectiveness and distributional cost- effectiveness of Louisiana’s MPE and PPD screening mandate from the patient, provider, payer, and social perspectives. The third aim will be to examine the complex contextual factors that influence adopting and implementing MPE and PPD screening mandates, and subsequent impacts on healthcare delivery, healthcare utilization, and maternal health equity within and between Louisiana and Mississippi. Findings will inform concurrent and future health policy strategies for informing, engaging, and empowering birthing people to improve maternal health outcomes and eliminate maternal health disparities in the United States.

抽象的 妊娠糖尿病（GDM）和妊娠高血压综合征（PIH）都会影响妊娠、分娩 结果和产后护理它们是糖尿病（T2DM）、高血压的独立危险因素。 （HTN）和心理健康问题，例如产后抑郁症（PPD）。 产后护理应包括血压 (BP)、血糖 (BG) 监测和 PPD 筛查， 目前的产后护理实践筛查率较低，特别是在医疗补助受益人中。 医疗补助覆盖了美国近一半的分娩，许多分娩者在 60 天内失去了医疗补助 2021 年《美国救援计划法案》为各州提供了延长产后期限的联邦资金。 保险期限长达 12 个月——路易斯安那州已经这样做了，而密西西比州还没有在 2022 年 8 月 1 日这样做。 路易斯安那州颁布了一项联邦命令，要求产后护理提供者筛查 PPD 及相关疾病 利用我们与国家出生公平合作组织的合作和联合治疗。 专业知识，我们建议评估医疗补助产后延期 (MPE) 和 PPD 筛查的效果 路易斯安那州 (LA) 对筛查行为、健康结果和患者体验的授权与 密西西比州 (MS) 分三个时期（2022-2023 年初、2024-2025 年中期和 2026-2027 年末）。 路易斯安那州和密西西比州的电子健康记录和医疗补助索赔数据，使我们能够跟踪筛查 和后续护理，即使在分娩后人们失去医疗补助覆盖范围。 为 BP、BG 和 PPD 的 3 个月综合筛查率 次要指标包括个体。 了解 T2DM、HTN 和 PPD 的筛查率、诊断和管理也很重要。 导致产后护理差异的背景因素和健康不平等，并估计 总体目标是评估这些政策的有效实施策略。 改善患有 GDM 或 PIH 的医疗补助受益人的产后健康。 研究将有三个具体目标：首先，我们将研究路易斯安那州 MPE 和 PPD 的有效性。 关于 BG 和 BP 监测率、PPD 筛查、T2DM、HTN 和 PPD 率的筛查任务 诊断、T2DM、HTN 和 PPD 管理、健康差异以及医疗保健利用率 第二个目标是检查成本效益和分配成本。 路易斯安那州 MPE 和 PPD 筛查要求患者、提供者、付款人和社会团体的有效性 第三个目标是研究影响采用和实施的复杂背景因素。 实施 MPE 和 PPD 筛查指令，以及对医疗服务、医疗保健的后续影响 路易斯安那州和密西西比州内部和之间的利用情况和孕产妇健康公平性的调查结果将提供信息。 当前和未来的卫生政策战略，旨在告知、参与和赋予分娩者权力 改善美国孕产妇健康结果并消除孕产妇健康差异。