Leveraging Linked Data to Evaluate Social and Spatial Disparities in Contraception Access and Regional Program Impacts

项目摘要/摘要 意外怀孕发生在各种情况下，对个人的风险有多种影响。主要 减少意外怀孕的循证干预措施是消除成本障碍和增加 避孕覆盖率。联邦、州和地方各级的政策和计划可能会影响 计划生育服务的可获得性和可负担性以及意外怀孕率。这些 项目可能会对个人产生不同的影响，这取决于人们的居住地和其他社会 健康的决定因素。 这项建议的主要研究目标是：1)确定人类可持续发展对人口水平的影响 意外怀孕和出生结局，目标2)确定计划生育服务的地区差异 利用UPDB关联的所有付款人索赔、电子医疗记录、地理空间 标记、人口统计资料和出生证明，以及目标3)建立关联数据基础设施，以便及时 评估避孕政策和方案的短期和长期影响。对于目标1，我将检查 县级避孕措施Her Salt Lake(n=11,498)的影响，采用配对对照设计。 使用差异性设计，我将比较意外怀孕率和出生结果 暴露的队列和匹配的对照组。在目标2中，我将使用地理信息系统(GIS) 评价区域间关联性的因果推理方法和层次回归方法 (大都市、小城市、农村和边疆地区)与计划生育利用和怀孕有关 结果。了解避孕方法和结果的地区差异，将有助于阐明地区 以证据为基础的政策和计划可以针对的差距。最后，在目标3中，我将建立一个 使用多个数据源的关联数据基础设施，以确定计划生育服务访问和 接受、个人寻求计划生育护理的过渡、避孕措施的使用和需求以及怀孕 以及生育结果随着政策变化而向前推进。 我将利用这个研究平台，结合卓越的指导和咨询团队，成为 避孕和生殖健康获取方案和政策的关联数据方法国家专家 评估。在此授奖期间，我将参与选定的培训活动：1)将主要数据与 多种行政数据来源；2)地理信息系统方法；3)应用保健政策 评估；以及4)领导力和导师。这项工作与医疗保健研究和机构保持一致 Quality的使命是提供证据，使医疗保健更容易获得和更公平。这 工作对AHRQ的重点人群有潜在的好处，特别是妇女、青少年、低收入和 农村居民。

PROJECT SUMMARY/ABSTRACT Unintended pregnancy occurs in a variety of contexts with multiple influences acting on individuals' risk. Primary evidence-based interventions for reducing unintended pregnancy are removal of cost-barriers and increase in contraceptive coverage. Policies and programs on the federal, state, and local level have the potential to affect the accessibility and affordability of family planning services and thus rates of unintended pregnancy. These programs may have differential effects on individuals depending on where people live and other social determinants of health. The overarching research goals of this proposal are to Aim 1) Determine population-level impacts of HER SL on unintended pregnancies and birth outcomes, Aim 2) Identify regional differences in family planning service utilization and outcomes using the UPDBs' linked all-payer claims, electronic medical records, geospatial markers, demographic profiles, and birth certificates, and, Aim 3) Establish linked-data infrastructure for timely evaluation of contraception policy and programs on short- and long-term impacts. For Aim 1, I will examine impacts from a county-level contraceptive initiative, HER Salt Lake (n=11,498), using a matched-control design. Using a difference-in-difference design, I will compare unintended pregnancy rates and birth outcomes between the exposed cohort and the matched controls. In Aim 2, I will employ geographic information systems (GIS) methods and hierarchical regression methods for causal inferences to evaluate associations between region (metropolitan, micropolitan, rural, and frontier areas) and family planning utilization and pregnancy related outcomes. Understanding regional variation in contraception access and outcomes, will elucidate regional disparities that can be targeted with evidence-based policy and programs. Finally, in Aim 3, I will establish a linked-data infrastructure using multiple data sources to pinpoint changes in family planning service access and uptake, transitions of where individuals seek family planning care, contraceptive use and need, and pregnancy and birth outcomes moving forward in relation to policy changes. I will use this research platform in combination with an exceptional mentorship and advisory team to become a national expert in linked-data approaches to contraception and reproductive health access program and policy evaluations. During this award period, I will engage in selected training activities in 1) linking primary data to multiple administrative data sources; 2) geographical information systems methodology; 3) applied health policy evaluation; and 4) leadership and mentorship. This work aligns with the Agency for Healthcare Research and Quality's (AHRQ) mission to produce evidence that makes healthcare more accessible and more equitable. This work has potential benefits for AHRQ's priority populations specifically, women, adolescents, low income, and rural residents.