Impact of Medicaid Postpartum Coverage Extension and Mandated Postpartum Depression Screening on Care for Gestational Diabetes and Pregnancy-Induced Hypertension

医疗补助产后覆盖​​范围扩大和强制性产后抑郁症筛查对妊娠期糖尿病和妊娠高血压综合征护理的影响

• 批准号: 10749378
• 负责人: LIZHENG SHI
• 金额: $ 65.41万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749378
• 关键词: Adopted; Affect; American; Antidepressive Agents; Birth; Blood Glucose; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Collaborations; Complex; Complications of Diabetes Mellitus; Cost Analysis; Cost Effectiveness Analysis; Data; Depression screen; Diabetes Mellitus; Diagnosis; Disparity; Eclampsia; Effectiveness; Electronic Health Record; Equity; Evaluation; Funding; Future; Gestational Diabetes; Goals; Health; Health Disparities Research; Health Personnel; Health Policy; Health behavior and outcomes; Health system; Healthcare; Hypertension; Individual; Kidney Diseases; Life; Link; Louisiana; Maternal Health; Maternal health equity; Measures; Medicaid; Mental Health; Mental disorders; Mississippi; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Measure; Patients; Persons; Policies; Policy Analysis; Postnatal Care; Postpartum Depression; Postpartum Period; Pre-Eclampsia; Pregnancy; Preventive service; Provider; Psyche structure; Recommendation; Risk; Risk Factors; Structure; Target Populations; United States; Vulnerable Populations; beneficiary; cardiovascular disorder risk; community based participatory research; contextual factors; cost effectiveness; cost estimate; effectiveness evaluation; effectiveness measure; empowerment; ethnic minority; experience; follow-up; glucose monitor; health care delivery; health care service utilization; health disparity; health equity; health inequalities; high risk; implementation strategy; improved; marginalization; outcome disparities; patient engagement; patient oriented; postpartum care; postpartum health; pregnancy hypertension; racial minority; scale up; screening; social; socioeconomic disadvantage; synergism

Abstract Both gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) affect pregnancy, birth outcomes, and postpartum care. They are independent risk factors for diabetes mellitus (T2DM), hypertension (HTN), and mental health conditions such as postpartum depression (PPD). Despite recommendations that postpartum care should include blood pressure (BP), blood glucose (BG) monitoring, and PPD screening, current postpartum care practices have low screening rates, especially among Medicaid beneficiaries. While Medicaid covers nearly half of deliveries in the United States, many birthing people lose coverage 60 days after birth. The American Rescue Plan Act of 2021 provided states with federal funding to extend postpartum coverage up to 12 months – Louisiana has done so while Mississippi has not. Additionally, on August 1, 2022, Louisiana enacted a statewide mandate requiring providers of postnatal care to screen for PPD and related mental health disorders. Using our collaboration with the National Birth Equity Collaborative and combined expertise, we propose to evaluate the effects of the Medicaid postpartum extension (MPE) and PPD screening mandate on screening behaviors, health outcomes, and patient experiences in Louisiana (LA) compared to Mississippi (MS) over three periods (early 2022-2023, middle 2024-2025, and late 2026-2027). We will link electronic health records and Medicaid claims data in Louisiana and Mississippi, allowing us to track screening and follow-up care even after birthing people lose Medicaid coverage. The primary effectiveness measure will be a 3-month composite screening rate for BP, BG, and PPD. Secondary measures include individual screening rates, diagnoses, and management of T2DM, HTN, and PPD. It is also critical to understand contextual factors and health inequities that contribute to disparities in postpartum care and to estimate the cost-effectiveness of these policies. The overall goal is to evaluate effective implementation strategies that aim to improve maternal postpartum health in Medicaid beneficiaries with GDM or PIH. To achieve this goal, the study will have three specific aims. First, we will examine the effectiveness of Louisiana’s MPE and PPD screening mandate on the rates of BG and BP monitoring, PPD screening, rates of T2DM, HTN, and PPD diagnoses, T2DM, HTN and PPD management, health disparities, and health care utilization, as compared to counterparts in Mississippi. The second aim will be to examine the cost-effectiveness and distributional cost- effectiveness of Louisiana’s MPE and PPD screening mandate from the patient, provider, payer, and social perspectives. The third aim will be to examine the complex contextual factors that influence adopting and implementing MPE and PPD screening mandates, and subsequent impacts on healthcare delivery, healthcare utilization, and maternal health equity within and between Louisiana and Mississippi. Findings will inform concurrent and future health policy strategies for informing, engaging, and empowering birthing people to improve maternal health outcomes and eliminate maternal health disparities in the United States.

摘要