Policy solutions for addressing structural racism in maternal health disparities

解决孕产妇健康差异中的结构性种族主义的政策解决方案

• 批准号: 10748871
• 负责人: GUOHUA LI
• 金额: $ 50.91万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 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/10748871
• 关键词: Address; Automobile Driving; Birth; Black race; Caring; Childbirth; Cities; Communities; Community Hospitals; Complement; Country; County; Data; Development; Dimensions; Disparity; Disparity population; Education; Effectiveness; Employment; Ensure; Equity; Ethnic Origin; Exclusion; Focus Groups; Health Care Costs; Health Policy; Health system; Healthcare; Height; Hospital Administrators; Hospital Costs; Hospitals; Imprisonment; Improve Access; Incidence; Inequity; Institutional Practice; Intervention; Interview; Life Experience; Link; Maternal Health; Maternal Health Services; Maternal Mortality; Maternal health equity; Measures; Medicaid; Medicaid eligibility; Methods; Morbidity - disease rate; New York City; Not Hispanic or Latino; Outcome; Patient-Centered Care; Patients; Persons; Play; Policies; Politics; Population; Postpartum Period; Pregnancy; Procedures; Public Policy; Race; Records; Research; Research Methodology; Research Project Grants; Research Technics; Risk; Risk Factors; Role; Sampling; Science; Site; Sterile coverings; Structural Racism; Structure; System; Techniques; Testing; Translating; United States National Institutes of Health; Urban Hospitals; Washington; Work; black/white disparity; career development; community engagement; community organizations; cost estimate; data modeling; disparities in morbidity; disparity reduction; ethnic disparity; ethnic minority; evidence base; experience; health data; health disparity; health equity promotion; health inequalities; improved; indexing; insight; intervention effect; maternal outcome; mortality; mortality disparity; mortality risk; multilevel analysis; multiple data sources; prospective; racial determinant; racial disparity; racial minority; racial population; racism; residence; residential segregation; safety net; segregation; severe maternal morbidity; social determinants; societal costs; structural determinants; suicidal; system-level barriers; theories

The broad, long-term objective of NY-CHAMP's Project 3 is to inform efforts to improve population maternal health equity by understanding and addressing the underlying determinants of racial and ethnic disparities in severe maternal morbidity (SMM) and mortality (MM) and ensuring equitable access to quality, culturally appropriate maternal health care. U.S. racial and ethnic minoritized birthing people are about three times as likely as non-Hispanic White birthing people to experience life-threatening complications and die during pregnancy and postpartum. Persistent racial and ethnic disparities in maternal health are not fully explained by known risk factors. Although structural racism (SR) is viewed as the fundamental cause of health disparities generally, few, if any, studies have empirically evaluated it role in excess SMM and mortality among racial and ethnic minority birthing people. Evidence regarding effective policy interventions—at state, local and hospital levels—to address SR in SMM/MM is even more scant. We propose a rigorous mixed methods project with specific aims to: 1) assess the associations of multidimensional indexes of SR with racial and ethnic disparities in SMM, suicidality, and mortality; and estimate the hospital costs of SMM attributable to SR; 2) assess the associations of two policy-relevant interventions (i.e., Medicaid eligibility generosity and healthcare workforce diversity) with racial and ethnic disparities in SMM, suicidality, and mortality; and quantify the moderating effects of these two interventions on associations between SR and maternal health outcomes; and 3) analyze the lived experiences of patients and community and hospital stakeholders to identify the mechanisms of, and effective solutions for, SR in maternal health care. We will analyze a robust triangulated set of quantitative and qualitative data from multiple sources, capturing both national and local samples, and apply a complementary suite of multilevel modeling, causal inference, and grounded theory research techniques. Data from the Healthcare Cost and Utilization Project, which provides information on 10 million childbirths from over 1200 hospitals in 21 states during 2016-2022 (Aims 1-2), will be complemented by prospective in-depth interview and focus group data from multisector stakeholders (patients, community, hospital) in three New York City hospital sites (Brooklyn, Washington Heights, Queens) of focus for NY-CHAMP's Intervention Project 2. Aims 1 and 2 will test the hypotheses that: 1) multidimensional indexes of SR are associated with significantly increased disparities in SMM, suicidality, and mortality; 2) higher state Medicaid eligibility generosity and healthcare workforce diversity are independently associated with lower disparities in SMM, suicidality, and mortality; and 3) Medicaid eligibility generosity and healthcare workforce diversity independently mitigate the impact of SR on disparities in maternal outcomes. Aim 3 will be hypothesis generating. Findings will help close important gaps in our understanding of the role that SR plays in SMM/MM disparities and generate urgently needed evidence for informing multilevel policy interventions to improve maternal health equity in our city, state, and across the country.

NY-CHAMP项目3的广泛和长期目标是为改善孕产妇人口的努力提供信息 通过了解和解决#年种族和族裔差距的根本决定因素，实现卫生公平 严重的孕产妇发病率(SMM)和死亡率(MM)，并确保在文化上公平获得优质服务 适当的孕产妇保健。美国种族和民族小规模的生育人口大约是 作为非西班牙裔白人分娩的人可能会经历危及生命的并发症并在 怀孕和产后。产妇健康方面持续存在的种族和民族差异不能完全解释为 已知的风险因素。尽管结构性种族主义(SR)被视为健康差距的根本原因 一般说来，很少有研究(如果有的话)经验性地评估了它在种族和种族中超过SMM和死亡率的作用 少数民族生育人口。关于有效政策干预的证据--在州、地方和医院 级别--在SMM/MM中解决SR问题就更少了。我们提出了一个严格的混合方法项目， 具体目的是：1)评估SR的多维指数与种族和民族差异的关联 在SMM中，自杀和死亡率；并估计可归因于SR的SMM的住院成本；2)评估 两项与政策相关的干预措施(即医疗补助资格慷慨和医疗保健工作人员)之间的关联 多样性)，以及在自杀率、自杀率和死亡率方面的种族和民族差异；并量化缓和效应 这两种干预措施中关于SR与孕产妇健康结局之间的关系的干预；以及3)分析 患者、社区和医院利益相关者识别机制和有效性的经验 产妇保健中SR的解决方案。我们将分析一组稳健的定量和定性的三角集合 来自多个来源的数据，捕获国家和地方样本，并应用一套互补的 多层次建模、因果推理和扎根的理论研究技术。来自医疗保健成本的数据 和利用项目，该项目提供了来自21个州1200多家医院的1000万名新生儿的信息 在2016-2022年期间(目标1-2)，将辅之以来自以下方面的预期深入访谈和焦点小组数据 纽约市三个医院站点(布鲁克林、 皇后区华盛顿高地)是纽约冠军干预项目2的焦点。目标1和目标2将测试 假设：1)SR的多维指数与显著增加的 SMM、自杀率和死亡率；2)更高的州医疗补助资格慷慨和医疗保健人员多样性 独立地与SMM、自杀率和死亡率方面的较低差异相关；以及3)符合医疗补助资格 慷慨和医疗保健人员的多样性独立地缓解了SR对孕产妇收入差距的影响 结果。目标3将产生假设。这些发现将有助于弥合我们对 SR在SMM/MM差异中所起的作用，并为多层次提供急需的证据 政策干预，以改善我市、州和全国的孕产妇健康公平。