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：妇女在退伍军人事务部人口中所占的比例越来越大，特别是在年轻的退伍军人中。迄今 还没有对女性退伍军人的怀孕结果进行全面评估， 需要，特别是考虑到退伍军人的怀孕风险高于一般人群。 重要性：鉴于女性退伍军人的比例越来越大，怀孕风险增加，以及已知的美国 种族和地理孕产妇健康差异，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 VA妇女健康服务办公室（WHS）努力改善怀孕护理和结果。 创新和影响：现有的最先进的方法将创新地应用于检查国家VA 和州医疗补助记录平行，以全面评估VA产妇护理。该项目是第一个 在全国范围内严格比较VA妊娠结局与普通人群的妊娠结局。 具体目标：目标1。这个目标有两个部分，其中第一个是纯粹描述性的：我们将描述一个广泛的 一系列关键的孕产妇结局，检查随时间推移的趋势和变化（关于关键的VA政策 变化）的所有怀孕，其中VA提供怀孕护理（购买）。关键的产妇成果将 包括剖腹产、妊娠并发症和严重孕产妇发病率（SMM），CDC定义 一系列严重危及生命的产妇并发症我们还将描述广泛的孕产妇风险 因素（个人健康因素，种族和地理的系统因素）和过程结果，包括 使用产前护理、退伍军人事务部心理保健和产后重返退伍军人事务部护理。我们还将研究 具有已知风险因素的退伍军人在适合其风险水平的环境中提供，因为结果是 当高风险分娩发生在次优环境中时，情况显然更糟。同时，我们将评估关键 婴儿结局（例如，死亡率、早产和意外的NICU入院-即非早产婴儿）。 目标1的最后一部分将使用回归分析来研究VA政策变化对关键 结果，同时还分析了种族/民族和城市/农村在结果方面的差距程度。 目标2：对VA入组的退伍军人进行分娩，同时重复目标1的描述性分析， 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在 特征和产妇结局。由于他们选择不让VA支付他们的交付，我们将 还评估他们在分娩前后几年对VA护理的使用，以确定是否选择非VA 妊娠护理是暂时或持久的医疗保健转移远离VA。 目标3：比较关键成果（例如，并发症发生率和SMM）， 医疗补助覆盖的退伍军人分娩与普通人群一样。检查是否存在已知差异 种族/民族和城市/农村的出生结果在VA或医疗补助覆盖的退伍军人中更明显/更不明显。 方法：将使用已建立的CDC方法检索VA行政记录，包括 购买护理，以确定所有登记的妇女退伍军人谁接受怀孕护理，延伸到 2000年，VA首次覆盖怀孕，直到2021年。这些数据将得到所有年份的补充。 可用的医疗补助数据。除描述性分析外，还将使用回归分析调整 已知的风险因素和调节因素，以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。研究小组领导 由国际公认的专家在评估围产期护理，他们有所有需要的 专家们将利用其专门知识进行适当的分析并有效地传播调查结果。 后续步骤/实施：我们与WHS密切合作，分享结果并根据其信息定制分析 需求妇女卫生部可以通过向退伍军人事务部所有设施的产妇护理协调员发出指令，直接实施变革。