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

利用关联数据评估避孕药具获取和区域计划影响方面的社会和空间差异

• 批准号: 10054744
• 负责人: JESSICA N SANDERS
• 金额: $ 15.7万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10054744
• 关键词: Leveraging; Linked; Data; Evaluate; Social

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.

项目总结/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。初级 减少意外怀孕的循证干预措施是消除成本障碍， 避孕普及率。联邦、州和地方各级的政策和计划有可能影响 计划生育服务的可获得性和可负担性，从而提高意外怀孕率。这些 根据人们的居住地和其他社会因素， 健康的决定因素。 本提案的首要研究目标是：1）确定HER SL对人群水平的影响 意外怀孕和生育结果，目标2）查明计划生育服务的区域差异 利用和结果使用的CMBs的链接所有付款人索赔，电子医疗记录，地理空间 标记，人口概况和出生证明，以及，目标3）建立链接数据基础设施， 评估避孕政策和方案的短期和长期影响。对于目标1，我将研究 来自县级避孕措施HER盐湖（n= 11，498）的影响，采用匹配对照设计。 使用差异中差异设计，我将比较 暴露组和对照组。在目标2中，我将使用地理信息系统（GIS） 方法和层次回归方法的因果推理，以评估地区之间的关联 （大都市、小都市、农村和边境地区）和计划生育利用率以及与怀孕有关的 结果。了解避孕药具获得和结果的区域差异，将阐明区域 可以通过循证政策和方案加以针对的差距。最后，在目标3中，我将建立一个 使用多个数据源的链接数据基础设施，以查明计划生育服务获取方面的变化， 个人寻求计划生育护理的地点、避孕药具的使用和需求以及怀孕的接受、转变 和生育结果的变化。 我将利用这个研究平台，结合一个特殊的导师和咨询团队，成为一个 避孕和生殖健康获取方案和政策的链接数据方法国家专家 评价。在此期间，我将参与选定的培训活动，1）将原始数据与 多种行政数据来源; 2）地理信息系统方法; 3）应用卫生政策 评价; 4）领导和指导。这项工作与医疗保健研究机构保持一致， 质量（AHRQ）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的优先人群有潜在的好处，特别是妇女、青少年、低收入者， 农村居民