Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD)

患有围产期情绪和焦虑症 (PMAD) 的私人受保女性的心理健康保险与结果之间的关系

• 批准号: 10197277
• 负责人: Kara Zivin
• 金额: $ 23.38万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-08 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197277
• 关键词: Accidental Injury; Address; Administrative Supplement; Adoption; Affect; Alcohol or Other Drugs use; American; Anxiety Disorders; Awareness; Caring; Cessation of life; Clinical; Data Mart; Death Certificates; Detection; Developed Countries; Diagnosis; Enrollment; Ethnic Origin; Face; Feeling suicidal; Funding; Future; Generations; Grant; Health; Health Benefit; Health Insurance; Health Policy; Health Services; Health system; Healthcare; Homicide; Hospitalization; Income; Infant; Insurance; Insurance Coverage; Intervention; Laws; Life; Low income; Maternal Health; Maternal Mortality; Measurement; Medical; Mental Health; Mood Disorders; Mothers; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Overdose; Patients; Perinatal; Perinatal mortality demographics; Pharmaceutical Preparations; Policies; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Procedures; Quality of Care; Race; Reporting; Research; Risk; Sampling; Savings; Self-Injurious Behavior; Services; Statutes and Laws; Subgroup; Substance Use Disorder; Suicide; Suicide attempt; United States; United States National Institutes of Health; Vision; Vulnerable Populations; Woman; Work; addiction; base; behavior influence; behavioral health; cohort; cost; economic outcome; experience; health care delivery; health plan; high risk; high risk population; improved; innovation; insight; interest; intergenerational; mortality; multiple data sources; parity; perinatal outcomes; perinatal period; population based; pregnancy related death; prevent; racial diversity; self diagnosis; severe maternal morbidity; statistics

This study directly responds to Notice of Special Interest (NOSI): Administrative supplements for NIH grants to add or expand research focused on maternal mortality (NOT-OD-20-104). The United States fares worst among developed nations in preventing pregnancy-related deaths; over the past two decades, mortality rates doubled in the US while decreasing elsewhere. For every maternal death, >100 women experience severe maternal morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during delivery hospitalization. Striking disparities in severe maternal morbidity and mortality (SMMM) persist even though two-thirds of SMMM cases may be preventable. Non-Hispanic Black and low-income women have significantly higher rates of SMMM compared to their counterparts. Behavioral Health (BH) conditions such as suicide, drug overdose, homicide, and unintentional injury are among leading contributors to SMMM, yet these deaths are excluded from population-based pregnancy-related death statistics, likely leading to underestimates of SMMM. In addition to BH causes of SMMM, BH conditions may exacerbate SMMM from other causes. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and subsequent federal legislation affecting mental health and substance use disorder benefits, provided one of the largest expansions of behavioral health (BH) coverage in a generation by increasing coverage and extending federal parity protections to over 60 million Americans. Most health plans, including commercial, employer-based plans must cover BH care and cannot provide less generous BH coverage relative to medical/surgical care. Over half of pregnant women are privately insured, and improved coverage due to BH policy changes could affect their BH service receipt. The proposed study capitalizes on R01MH120124, which examines how federal BH policy changes affect outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine SMMM overall and among high-risk populations. It will use a large, economically, racially diverse national sample of enrollees in employer- based insurance, Optum, from 2005-2018. This proposed one-year study will use patient- and plan-level analyses of delivering women to examine associations of mandated federal BH policy changes with: 1) changes in SMMM in the perinatal period (e.g., 21 severe maternal morbidity indicators, overdose, suicidality, and death from any cause during pregnancy, delivery hospitalization, and up to one year postpartum; 2) changes in SMMM within high-risk subgroups. For each Aim 1 outcome, we will examine how changes vary: 1) for those with and without co-occurring PMAD and substance use disorders; 2) by race/ethnicity, 3) by income, 4) in states with strong vs. weak pre-existing parity laws, and 5) in plans subject to new parity laws vs. those not subject to the laws. Despite growing awareness of lethal consequences delivering women face, we know little about BH contributors to these outcomes. For NIH to effectively Implement a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE), we must not ignore the impact of BH conditions, treatments, and coverage policies.

本研究直接回应特别兴趣通知 (NOSI)：NIH 拨款的行政补充 添加或扩展针对孕产妇死亡率的研究（NOT-OD-20-104）。美国的情况最差 发达国家预防与妊娠相关的死亡；过去二十年，死亡率翻了一番 美国，而其他地区则有所下降。每发生一次孕产妇死亡，就有超过 100 名妇女经历严重的孕产妇死亡 发病、危及生命的诊断，或在分娩住院期间接受挽救生命的手术。 尽管三分之二的孕产妇严重发病率和死亡率（SMMM）仍然存在显着差异 SMMM 病例可能是可以预防的。非西班牙裔黑人和低收入女性的比率明显更高 SMMM 与同行相比。行为健康 (BH) 状况，例如自杀、药物过量、 凶杀和无意伤害是 SMMM 的主要原因，但这些死亡被排除在外 来自基于人群的妊娠相关死亡统计数据，可能导致 SMMM 被低估。在 除了 SMMM 的 BH 原因外，BH 状况也可能因其他原因而加剧 SMMM。 2008 年心理健康平等和成瘾公平法案 (MHPAEA) 以及随后的联邦立法 影响心理健康和物质使用障碍的好处，提供了行为的最大扩展之一 通过增加覆盖范围并将联邦平等保护范围扩大到 60 多个，在一代人的时间内实现健康 (BH) 覆盖 百万美国人。大多数健康计划，包括商业、雇主计划必须涵盖 BH 护理和 无法提供相对于医疗/手术护理而言不那么慷慨的 BH 保险。超过一半的孕妇 私人保险以及由于 BH 政策变化而提高的覆盖范围可能会影响他们的 BH 服务收入。 拟议的研究利用了 R01MH120124，该研究探讨了联邦 BH 政策变化如何影响 围产期情绪和焦虑障碍（PMAD）的结果。本研究将全面考察 SMMM 高危人群。它将使用大量的、经济上、种族上多样化的国家样本来雇用雇主—— 2005 年至 2018 年期间，基于 Optum 的保险。这项拟议的为期一年的研究将使用患者和计划层面的分析 让女性检查强制性联邦 BH 政策变化与以下因素之间的关系：1) SMMM 的变化 围产期（例如 21 项严重的孕产妇发病指标、服药过量、自杀倾向以及因任何药物导致的死亡） 怀孕期间、分娩住院期间以及产后一年内的原因； 2）SMMM内的变化 高风险亚组。对于每个目标 1 的结果，我们将检查变化如何变化：1) 对于有和没有的人 PMAD 和物质使用障碍同时发生； 2) 按种族/民族，3) 按收入，4) 强国与弱国的州 现有的平等法较弱，5) 受新平等法约束的计划与不受该法律约束的计划。 尽管人们越来越意识到分娩妇女面临的致命后果，但我们对 BH 贡献者知之甚少 到这些结果。 NIH 有效实施孕产妇健康和妊娠成果愿景 大家（改进），我们不能忽视 BH 条件、治疗和承保政策的影响。