Reducing Maternal Health Disparities: Effects of Recent Health Workforce Policies

项目摘要/摘要 美国正面临着孕产妇死亡率和严重发病率上升的严重危机，这是 可归因于多种因素，例如#年产妇保健人员持续严重短缺 弱势城市社区和农村地区。因为美国一半的县都没有一个 妇产科医生(OB-GYN)，获得产妇保健是近七年来面临的一项艰巨挑战 生活在这些县的100万育龄妇女。 为了解决临床医生分布不均的问题，政策制定者做出了相当大的努力 在最近几十年里。在这些努力中，国家卫生服务团(NHSC)仍然是最大的单一机构 已经启动的政策干预，为卫生专业人员短缺地区(HPSA)招募临床医生。 在过去的十年中，NHSC经历了戏剧性的扩张，首先是通过美国 2009年通过了《复苏和再投资法案》，2010年又通过了《平价医疗法案》。先前的研究发现 这两项法案使NHSC的年度预算增加了100%以上，并导致显著扩大了 NHSC的临床医生队伍，如妇产科医生和合格的护士-助产士。然而，到目前为止还没有研究 评估了NHSC扩大对孕产妇保健差距和男女之间结局的影响 HPSA和其他领域。 这个拟议的项目旨在研究这些问题并填补文献中的空白。据我们所知，它 将是第一项研究，以检查最近的NHSC扩大对孕产妇保健和 结果。具体地说，该项目旨在评估最近的NHSC扩张如何影响以下方面的差距(1) 产妇总死亡率，特别是住院死亡率；(2)分娩期间的严重产妇发病率 住院和相关的住院分娩费用和住院时间，(3)分娩和分娩护理，以及 (4)产前护理和分娩结局的时机和充分性。 为了审查这些目标，我们将使用延长15年的多个大型国家数据文件 在2005至2019年间。为了分析数据，我们将采取两种互补的方法，包括 差异法和工具变量法。我们的分析有望提供 劳动力政策变化对孕产妇收入差距影响的严格准实验证据 死亡率和严重发病率，这是2030年健康人的关键目标。我们的研究结果将 对即将实施的2018年《改善产妇保健服务的机会》有重要影响 ACT，最新的NHSC政策变化旨在通过进一步 增加保健服务中心支持产妇护理提供者。

PROJECT SUMMARY/ABSTRACT The U.S. is facing a serious crisis of rising rates of maternal mortality and severe morbidity, which are attributable to multiple factors, such as the persistent, deep shortages of maternal care workforce in disadvantaged urban communities and rural areas. Since half of U.S. counties do not have a single obstetrician-gynecologist (OB-GYN), access to maternal care is a daunting challenge facing the nearly seven million reproductive-age women living in those counties. To address the problem of unequal distribution of clinicians, policymakers have taken considerable efforts in recent decades. Among the efforts, the National Health Service Corps (NHSC) remains the single largest policy intervention that has been launched to recruit clinicians to health professional shortage areas (HPSAs). The NHSC has experienced a dramatic expansion during the past decade, first through the American Recovery and Reinvestment Act in 2009 and then by the Affordable Care Act in 2010. Prior studies have found that these two Acts have raised the NHSC’s annual budget by over 100% and led to a significant expansion of the NHSC’s clinician workforce, such as OB-GYNs and certified nurse-midwives. However, no study to date has evaluated the impact of the NHSC expansion on disparities in maternal care and outcomes between the HPSAs and other areas. This proposed project aims to examine these issues and fill the gap in the literature. To our knowledge, it will be the first study to examine the effect of the recent NHSC expansion on disparities in maternal care and outcomes. Specifically, the project aims to assess how the recent NHSC expansion affects disparities in (1) maternal mortality overall and in-hospital mortality in particular, (2) severe maternal morbidity during childbirth hospitalizations and the associated hospital delivery costs and length of stay, (3) labor and delivery care, and (4) timing and adequacy of prenatal care and birth outcomes. To examine these aims, we will use multiple large, national data files over an extended period of 15 years between 2005 and 2019. To analyze the data, we will take two complementary approaches, including a difference-in-differences method, and an instrumental variable approach. Our analyses are expected to provide rigorous quasi-experimental evidence about the effects of workforce policy changes on disparities in maternal mortality and severe morbidity, which are key objectives of the Healthy People 2030. Our study findings will have important implications for the upcoming implementation of the 2018 Improving Access to Maternity Care Act, the latest NHSC policy change intended to better serve reproductive-age women in HPSAs by further increasing the NHSC supported maternal care providers.