Medicaid Expansion in Oregon: Access and Health Outcomes for Women and Infants

说明(申请人提供)：对育龄妇女进行早期干预，以识别和治疗慢性病并纠正行为危险因素，有可能显著降低其发病率和死亡率，并改善她们的妊娠结局。缺乏医疗保险一直是对低收入育龄妇女进行早期干预和预防性护理的主要障碍。然而，2014年根据患者保护和平价医疗法案(ACA)扩大医疗补助将使数百万新的低收入女性有资格获得医疗补助和预防性医疗服务。一个综合数据系统对于评估这一扩展对育龄妇女及其婴儿健康的影响至关重要。使用该数据系统的研究将为未来的计划规划提供信息，并确定最佳做法和最需要的领域。我们建议创建一个集成数据系统，将俄勒冈州的医疗补助数据与出生和死亡证明以及出院数据联系起来。此外，我们将包括其他州无法获得的医疗补助服务质量数据。这项拟议的研究是俄勒冈州立大学和俄勒冈州卫生局合作进行的。俄勒冈州是进行这项拟议研究的理想州，因为该州对医疗补助医疗保健提供改革的持续承诺，以及州领导人承诺跨部门和项目合作，以确保该项目的成功。该项目还得到了国家在妇幼保健和妇女保健方面的主要利益攸关方的支持。该提案的具体目标是：1)与主要利益攸关方合作，制定研究议程，以评估医疗补助计划在俄勒冈州符合医疗补助条件的育龄妇女、母亲和婴儿健康方面的扩大；2)将俄勒冈州15-44岁女性参与者及其婴儿的医疗补助数据与全州范围的数据集联系起来，包括(但不限于)活产、胎儿死亡、婴儿死亡和出院数据，从2008年开始，随着数据的可用，一直持续到2016年；以及3)进行有计划的分析并传播研究结果。研究议程将包括关键的研究问题，这些问题将评估扩大医疗补助对低收入妇女的医疗补助登记和获得护理的影响；参加医疗补助的妇女和婴儿对服务的利用；这些妇女的一般健康行为、风险和结果；以及怀孕并发症和不良生育结果。我们还将衡量医疗补助扩大后仍然存在的差距，以便为持续缩小这些差距的战略提供信息。我们将使用这些分析的结果来构建模拟，将这项研究的发现扩展到对正在扩大医疗补助的其他州的政策制定者和利益相关者的影响和教训。这些分析和模拟的结果将提供有价值的信息，以支持俄勒冈州和美国各地的医疗改革努力，以减少公共卫生负担，改善育龄妇女的人口健康，包括怀孕和婴儿健康结果。

DESCRIPTION (provided by applicant): Early intervention to identify and treat chronic disease and modify behavioral risk factors among women of reproductive age has the potential to significantly reduce their morbidity and mortality and improve their pregnancy outcomes. Lack of health insurance has been a major barrier to early intervention and preventive care among low-income women of reproductive age. However, the 2014 expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) will make millions of low-income women newly eligible for Medicaid and preventive health services. An integrated data system is essential to evaluate the impact of this expansion on the health of women of reproductive age and their infants. Research using this data system will inform future program planning and identify best practices and areas of greatest need. We propose to create an integrated data system that links Oregon Medicaid data with birth and death certificates and hospital discharge data. Further, we will include data on the quality of Medicaid services that are not available to other states. The proposed study is a collaborative effort between Oregon State University and the Oregon Health Authority. Oregon is an ideal state in which to conduct the proposed study because of its ongoing commitment to Medicaid health care delivery reform and the commitment of state leaders to collaborate across divisions and programs to ensure this project's success. The project also has the support of key state stakeholders in maternal and child health and women's health. The specific aims of the proposal are to1) develop a research agenda, in collaboration with key stakeholders, to evaluate the expansion of Medicaid on the health of Medicaid-eligible women of reproductive age, mothers, and infants in Oregon; 2) link Oregon Medicaid data for female enrollees ages 15-44 and their infants to statewide datasets, including (but not limited to) live birth, fetal death, infant death, and hospital discharge data, beginning with 2008 and continuing until 2016, as data become available; and 3) conduct planned analyses and disseminate findings. The research agenda will include key research questions that assess the effect of Medicaid expansion on Medicaid enrollment and access to care for low-income women; utilization of services by women and infants enrolled in Medicaid; general health behaviors, risks, and outcomes for these women; and pregnancy complications and poor birth outcomes. We will also measure disparities that remain after Medicaid expansion, to inform strategies to mitigate those disparities on an ongoing basis. We will use results of these analyses to construct simulations that extend this study's findings into implications and lessons for policy makers and stakeholders in other states that are expanding Medicaid. Results of these analyses and simulations will provide valuable information to support health reform efforts, both in Oregon and across the U.S, to reduce the public health burden and improve population health among women of reproductive age, including pregnancy and infant health outcomes.