A comprehensive assessment of maternal health and pregnancy outcomes among women veterans

女退伍军人孕产妇健康和妊娠结局的综合评估

• 批准号: 10599236
• 负责人: CIARAN S. PHIBBS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599236
• 关键词: Address; Admission activity; Affect; Age; Age Distribution; Area; Back; Birth; California; Caring; Cesarean section; Characteristics; Communities; Complication; Data; Diffusion; Discipline of obstetrics; Disparity; Enrollment; Equity; Ethnic Origin; Evaluation; Feedback; General Population; Geography; Growth; Health; Healthcare; High-Risk Pregnancy; Hospitals; Individual; Infant; International; Learning; Life; Link; Literature; Maternal Age; Maternal Health; Maternal Mortality; Maternal complication; Medicaid; Mental Health; Mental Health Services; Methodology; Methods; Military Personnel; Neonatal; Neonatal Mortality; Newborn Infant; Outcome; Patients; Perinatal Care; Policies; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prenatal care; Process; Provider; Quality Indicator; Race; Records; Regression Analysis; Reproductive Health; Research; Research Priority; Risk; Risk Factors; Rural; Techniques; Time; Time trend; Translating; Translations; Veterans; Woman; Women' s Health Services; Work; care coordination; experience; health disparity; high risk; improved; infant outcome; innovation; maternal outcome; maternal risk; mortality; neonatal outcome; pregnant; premature; racial disparity; racial diversity; rapid growth; reproductive; rural disparities; rurality; severe maternal morbidity; trend; urban disparity; virtual

Background: Women are a growing share of the VA population, especially among younger Veterans. To date there hasn’t been a comprehensive assessment of pregnancy outcomes among women Veterans, which is needed, especially given that Veterans have higher pregnancy risk profiles than the general population. Significance: Given the growing share of women Veterans, their increased pregnancy risk, and known U.S. racial and geographic maternal health disparities, VA needs to better understand the provision and outcomes of pregnancy care to implement policies to optimize pregnancy outcomes for Veterans. Findings will facilitate the VA Office of Women’s Health Services (WHS) efforts to improve pregnancy care and outcomes. Innovation and Impact: Existing state of the art methods will be innovatively applied to examine national VA and state Medicaid records in parallel to comprehensively assess VA maternity care. This project is the first to rigorously compare VA pregnancy outcomes with those in the general population at a national level. Specific Aims: Aim 1. This aim has two parts, of which the first is purely descriptive: We will describe a wide range of key maternal outcomes, examining trends and changes over time (with respect to key VA policy changes) for all pregnancies where the VA provided pregnancy care (purchased). Key maternal outcomes will include cesarean deliveries, pregnancy complications and severe maternal morbidity (SMM), a CDC defined set of serious life-threatening maternal complications. We will also describe a broad range of maternal risk factors (individual health factors, and systemic factors of race and geography) and process outcomes including use of prenatal care, VA mental healthcare, and post-partum reintegration to VA care. We will also examine if Veterans with known risk-factors deliver at settings appropriate for their risk levels, as outcomes are demonstrably worse when high-risk deliveries occur in sub-optimal settings. Concurrently we will assess key infant outcomes (e.g., mortality, prematurity, and unexpected NICU admission—i.e. in non-preterm infants). The final part of Aim 1 will use regression analyses to examine the impacts of VA policy changes on key outcomes, while also analyzing the extent of racial/ethnic and urban/rural disparities in outcomes. Aim 2: Repeat, in parallel, the Aim 1 descriptive analyses, for deliveries to VA-enrolled Veterans who do NOT use VA maternity benefits, but instead use Medicaid. We will assess how these Veterans differ in characteristics and maternal outcomes. Since they have chosen not to have VA cover their delivery, we will also assess their use of VA care in the years prior to and after delivery to determine if opting for non-VA pregnancy care was a temporary or lasting healthcare shift away from VA. Aim 3: Compare key outcomes (e.g., complication rates and SMM) of VA-covered deliveries and of Medicaid-covered Veterans’ deliveries with those in the general population. Examine if known disparities racial/ethnic and urban/rural in birth outcomes are more/less pronounced in VA or Medicaid covered Veterans. Methodology: Established CDC methods will be used to search VA administrative records, including purchased care, to identify all enrolled women Veterans who received pregnancy care, extending back to 2000, when VA first covered pregnancy, through 2021. These data will be supplemented by all years of Medicaid data that are available. In addition to descriptive analysis, regression analyses will be used to adjust for known risk factors and moderators to examine a wide range of pregnancy outcomes. Causal inference techniques will be used to analyze the effect of VA and other policies on key outcomes. The study team is led by internationally recognized experts in the evaluation of perinatal care and they have all of the needed expertise to conduct appropriate analyses and effectively disseminate the findings. Next Steps/Implementation: We work closely WHS to share results and tailor analyses to their information needs. WHS can directly implement change via directives to maternity care coordinators at all VA facilities.

背景：妇女在VA人口中的份额越来越多，尤其是在年轻的退伍军人中。迄今为止 尚未对女性退伍军人的怀孕结局进行全面评估，这是 需要，特别是考虑到退伍军人的怀孕风险特征比一般人群更高。 意义：鉴于妇女退伍军人的份额越来越大，她们的怀孕风险增加以及已知的美国 种族和地理材料健康分布，VA需要更好地了解提供和结果 怀孕护理以实施政策，以优化退伍军人的怀孕结果。调查结果将有助于 弗吉尼亚州妇女卫生服务办公室（WHS）为改善怀孕护理和结果而做出的努力。 创新和影响：现有的最先进方法将用于审查国家弗吉尼亚州的审查 和州医疗补助的记录并行，可以全面评估VA产妇护理。这个项目是第一个 严格地将VA妊娠结局与全国一级的普通人群进行比较。 具体目的：目标1。这个目标有两个部分，其中第一个纯粹是描述性的：我们将描述一个广泛的 一系列关键的产妇结果，检查趋势和随着时间的变化（关于关键VA政策 更改）对于VA提供妊娠护理（购买）的所有怀孕（购买）。关键的母亲结果将 包括剖宫产，妊娠并发症和严重的母体发病率（SMM），CDC定义 一组严重的威胁生命的母亲并发症。我们还将描述广泛的母亲风险 因素（个人健康因素以及种族和地理的全身因素）以及过程结果包括 使用产前护理，VA心理保健和后果后的VA护理。我们还将检查是否 具有已知风险因素的退伍军人在适合其风险水平的情况下交付，因为结果是 当高风险交付在亚最佳设置中发生时，更恶化的情况更糟。同时我们将评估密钥 婴儿的结果（例如，死亡率，早产和意外的NICU入院 - 在非久保婴儿中）。 AIM 1的最后一部分将使用回归分析来检查VA政策变更对密钥的影响 结果，同时还分析了结果中种族/族裔和城市/农村差异的程度。 目标2：同时重复AIM 1描述性分析，以交付给VA注册的退伍军人 不要使用VA产妇福利，而是使用医疗补助。我们将评估这些退伍军人的不同 特征和孕产妇的结果。由于他们选择不覆盖VA的交付，我们将 还要评估他们在交货前后的几年中对VA护理的使用，以确定是否选择非VA 怀孕护理是暂时或持久的医疗保健，从VA转移。 目标3：比较va覆盖的交付的关键结果（例如并发症和SMM） 医疗补助覆盖的退伍军人与普通民众的交付。检查是否已知差异 在VA或医疗补助的退伍军人中，种族/族裔和城市/农村的出生成果中更为明显。 方法：已建立的CDC方法将用于搜索VA管理记录，包括 购买护理，以确定所有接受怀孕护理的入学妇女退伍军人 2000年，当VA首次涵盖怀孕到2021年时。这些数据将由所有年份的所有年份补充 可用的医疗补助数据。除了描述性分析外，还将使用回归分析来调整 为了使已知的危险因素和主持人检查广泛的妊娠结局。因果推断 技术将用于分析VA和其他政策对关键结果的影响。学习团队被领导 由国际认可的专家评估围产期护理，他们拥有所有所需的 进行适当分析并有效传播发现的专业知识。 下一步/实施：我们密切关注以分享结果并根据其信息量身定制分析 需要。 WHS可以通过指令直接实施所有VA设施的孕妇护理协调员的变更。