Doctoral Dissertation Research Improvement: Medical System-State Collaborations

博士论文研究的改进：医疗系统与国家的合作

• 批准号: 1802773
• 负责人: Claire Decoteau
• 金额: $ 1.1万
• 依托单位: University of Illinois at Chicago
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1802773&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Improvement; Medical

The study examines how government mandates affect medical responses to substance-using pregnant women. Federal and state mandates increasingly encourage medical providers to initiate punitive state responses when they suspect perinatal substance use by pregnant women. This challenges the professional role of medical personnel as providers of care to their patients. This study uses a variety of qualitative methods to investigate the actions of the different actors in this process, state actors, medical professionals, and pregnant women. Findings of this research have the potential to influence government policy-making concerning substance-using pregnant women as well as the responses of medical experts and maternal health advocates. This study employs a multi-level analysis to assess macro, micro, and intermediate level factors that mutually shape interventions on pregnant women. To assess macro-level processes, a systems-level analysis informed by interviews with stakeholders such as medical experts and child welfare advocates looks at how policy domains (including drug policy, child welfare policy, and maternal-fetal health policy) shape medical agendas and encourage medico-legal collaborations. At an intermediate level, a year-long ethnographic study of a Labor and Delivery unit uncovers how day-to-day medical practices are carried out and to what extent the state is invited into or intervenes upon these processes. At the micro level, semi-structured interviews with medical professionals and women directly affected by medically-initiated state sanctions show how medical-state collaborations affect care outcomes and patient well-being. A key consideration throughout is the role that social class and race play in shaping institutional responses.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

这项研究考察了政府指令如何影响对吸毒孕妇的医疗反应。联邦和各州的法令日益鼓励医疗提供者在怀疑孕妇使用围产期药物时采取惩罚性的州应对措施。这对医务人员作为病人护理提供者的专业角色提出了挑战。本研究采用多种定性方法，调查在这一过程中的不同行为者，国家行为者、医疗专业人员和孕妇的行为。这项研究的结果有可能影响政府关于使用药物的孕妇的决策，以及医学专家和孕产妇保健倡导者的反应。本研究采用多层次的分析来评估宏观、微观和中间水平的因素，这些因素相互影响对孕妇的干预。为了评估宏观层面的过程，通过对利益相关者（如医学专家和儿童福利倡导者）的访谈，进行系统级分析，研究政策领域（包括药物政策、儿童福利政策和母胎健康政策）如何塑造医疗议程并鼓励医学-法律合作。在中级水平上，对一个分娩单位进行为期一年的人种学研究，揭示了日常医疗实践是如何进行的，以及国家在多大程度上被邀请参与或干预这些过程。在微观层面，对医疗专业人员和直接受到医疗发起的国家制裁影响的妇女的半结构化访谈显示了医疗-国家合作如何影响护理结果和患者福祉。贯穿始终的一个关键考虑是社会阶级和种族在形成制度反应中所起的作用。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。