The Postpartum Assessment of Women Survey (PAWS): Informing Medicaid Policies to Improve Health in the "Fourth Trimester"

项目总结 出生后一年，也被称为“第四个三个月”，是一个越来越多的努力重点，以解决高发病率 美国的孕产妇发病率和死亡率，不成比例地影响种族-民族 少数民族、农村妇女和分娩时接受医疗补助的妇女。超过一半的与怀孕有关的死亡 发生在分娩后的第二年，相当一部分妇女由于身体原因而经历产后发病率 以及精神健康状况。作为美国近一半的新生儿和黑人中更大比例的新生儿的付款人 对于土著妇女而言，医疗补助是改善人口层面产后健康差距的关键杠杆。AS 新冠肺炎疫情消退，政策制定者正在考虑一系列医疗补助政策变化--单独 并与其他社会政策部门合作--旨在改善产后健康，如延长 怀孕、医疗补助、产后一年或解决社会风险因素。然而，产后的决定因素 人们对幸福感和健康差距知之甚少。这在很大程度上是因为第四个三个月一直是 产妇保健政策和研究的一个被忽视的重点。 为了推动基于证据的决策，并填补高质量、代表性数据方面的重大缺口 产后健康，我们的多学科团队开展了一项为期一年的大规模跟踪调查 与六个州和纽约市合作的产后妇女评估调查 (PAWS)。2020年的爪子捕捉到了2020年生下孩子的女性的产后经历 突发公共卫生事件(Phe)的高度。这一提议的项目利用并建立在这类项目的第一个基础上 数据收集工作，以回应政策制定者改善新的产后健康的迫切需求 公共卫生、政策和社会背景将随着大流行的消退而出现，随着政策和保护措施的实施 随着新政策的开始(例如，2022年延长产后医疗补助)。具体来说，我们将 在2023年出生队列(2024年收集的数据)之后启动新一轮PAWS调查，以衡量(1)产妇 产后一年的健康结果差异(按保险、种族和城乡居住地)，(2) 与保健相关的差异及其对产后健康结果差异的贡献，以及(3)社会 以及经济差异及其对产后健康结果差异的贡献。 利用我们由初级和高级调查人员组成的不同的跨学科团队的专业知识，并深入 与州和市政府合作伙伴合作，我们将产生一个非常有价值的科学资源 并生成及时、严格的调查结果，为基于证据的政策提供信息，并具有推进的潜力 美国的孕产妇健康公平。

PROJECT SUMMARY The year after birth, also known as the “fourth trimester”, is a growing focus of efforts to address high rates of maternal morbidity and mortality in the United States (U.S.), which disproportionally affect racial-ethnic minorities, rural women and women insured by Medicaid at delivery. More than half of pregnancy-related deaths occur in the year after delivery and a significant share of women experience postpartum morbidity due to physical and mental health conditions. As the payer for nearly half of U.S. births and a larger share of births among Black and Indigenous women, Medicaid is a key lever to improve population-level postpartum health disparities. As the COVID-19 pandemic subsides, policymakers are considering a range of Medicaid policy changes—alone and in conjunction with other social policy sectors—aimed to improve postpartum health, such as extending pregnancy Medicaid one year postpartum or addressing social risk factors. Yet, the determinants of postpartum wellbeing and health disparities are poorly understood. This is largely because the fourth trimester has been a neglected focus of maternal health policy and research. To drive evidence-based policymaking and fill the significant gap in high quality, representative data on postpartum health, our multidisciplinary team developed a large-scale follow-up survey administered one year after birth in collaboration with six states and New York City: the Postpartum Assessment of Women Survey (PAWS). The 2020 PAWS captured the postpartum experience of women who gave birth in 2020, during the height of the public health emergency (PHE). This proposed project leverages and builds on this first-of-its kind data collection effort to respond to the urgent needs of policymakers to improve postpartum health in the new public health, policy and social context that will emerge as the pandemic subsides, as the policies and protections of the PHE end, and as new policies begin (e.g. postpartum Medicaid extensions in 2022). Specifically, we will launch a new PAWS survey round following a 2023 birth cohort (data collected in 2024) to measure (1) maternal health outcome disparities in the postpartum year (by insurance, race-ethnicity, and urban/rural residence), (2) health care-related disparities and their contribution to disparities in postpartum health outcomes, and (3) social and economic disparities and their contribution to disparities in postpartum health outcomes. Drawing on expertise from our diverse, interdisciplinary team of junior and senior investigators, and in deep collaboration with state and city government partners, we will produce a highly valuable scientific resource and generate timely, rigorous findings to inform evidence-based policies with the potential to advance maternal health equity in the U.S.