Preconception Care and Severe Maternal Morbidity among Women with Medicaid

项目摘要 在美国，重度孕产妇发病率（SMM）在过去二十年中增加了近200%， 根据医疗保健机构最近的一份报告，2015年， 研究和质量（AHRQ）。美国的产妇死亡率仍然是所有发达国家中最高的。 每年约有52，000名美国女性经历SMM，定义为妊娠并发症， 对妇女造成严重不良后果或使其面临死亡风险。SMM不成比例 影响到种族和少数民族群体的妇女，低收入邮政编码的居民， 不管有没有医疗保险。尽管先前的研究已经确定了与 孕产妇死亡率和SMM风险增加，如年龄、种族和慢性病史，这些因素 仅占产科并发症变异的20-40%。估计分娩时的医院因素 仅占变异的20%，这表明上游因素对 SMM。一个上游因素是孕前保健，它被定义为患者接受的预防性保健 在怀孕前，以解决与怀孕有关的风险因素。孕前保健被誉为 预防不良妊娠结局和减少种族/民族差异的有希望的战略 这一做法有助于孕产妇和婴儿健康，但其对孕产妇结果的益处尚未得到证明。这 该项目将通过以下方式解决AHRQ利用数据改善医疗质量和患者结局的优先事项 使用国家医疗补助申请数据来解决不成比例地影响低收入的关键证据差距 妇女这项研究将为未来更大规模的研究奠定基础， 孕前保健和孕产妇结局。医疗补助数据提供了跟踪数百万女性的机会 随着时间的推移，通过多个护理站点，观察大量甚至罕见的不良结果。我们将 观察参加医疗补助计划的妇女中约1200万例怀孕，以制定和验证一项 基于索赔的孕前保健利用率测量。我们会找出 在医疗补助覆盖的所有妊娠中， 在慢性病患者中。最后，我们将评估SMM中种族/民族差异的数量 由于缺乏孕前保健。这将为将来的R 01测试因果关系奠定基础 增加获得孕前保健的机会与孕产妇结局之间的关系，这将直接影响 与保健政策和服务提供结构的相关性。

PROJECT SUMMARY In the United States, severe maternal morbidity (SMM) has increased nearly 200% in the past two decades, reaching a rate of 146 out of 10,000 births in 2015 according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). U.S. maternal mortality remains among the highest of all developed countries. Approximately 52,000 U.S. women per year experience SMM, defined as a pregnancy complication that causes significant adverse consequences for the woman or puts her at risk of death. SMM disproportionately affects women from racial and ethnic minority groups, residents of low-income zip codes, and those with Medicaid or no insurance. Although prior research has identified individual-level factors associated with increased risk of maternal mortality and SMM such as age, race, and history of chronic disease, these account for only 20-40% of the variation in obstetric complications. Hospital factors at the time of delivery are estimated to account for only another 20% of the variation, suggesting that upstream factors contribute significantly to SMM. One upstream factor is preconception care, which is defined as preventive healthcare a patient receives before pregnancy to address pregnancy-related risk factors. Preconception care has been hailed as a promising strategy to prevent adverse pregnancy outcomes and reduce racial/ethnic disparities in both maternal and infant health, but its benefits for maternal outcomes have not yet been demonstrated. This project will address AHRQ's priority of harnessing data to improve healthcare quality and patient outcomes by using national Medicaid claims data to address key evidence gaps that disproportionately affect low-income women. This study will lay the groundwork for a larger future study testing the causal link between preconception care and maternal outcomes. Medicaid data offer the opportunity to follow millions of women through multiple sites of care over time and observe large numbers of even rare adverse outcomes. We will observe approximately 12 million pregnancies among women enrolled in Medicaid to develop and validate a claims-based measure of preconception care utilization. We will identify the association between preconception care utilization and the risk of SMM among all pregnancies covered by Medicaid and specifically among individuals with chronic diseases. Finally, we will assess the amount of racial/ethnic disparities in SMM attributable to a lack of preconception care. This will lay the groundwork for a future R01 to test the causal relationship between increased access to preconception care and maternal outcomes, which will have direct relevance to healthcare policy and the structure of service delivery.