Policy solutions for addressing structural racism in maternal health disparities

NY-CHAMP项目3的广泛、长期目标是为改善人口孕产妇死亡率的努力提供信息。 通过了解和解决在卫生保健方面的种族和族裔差异的根本决定因素， 严重的孕产妇发病率和死亡率，并确保公平获得高质量、文化上 适当的产妇保健。美国种族和民族少数民族的生育人口大约是美国的三倍。 可能作为非西班牙裔白色分娩的人经历危及生命的并发症，并在分娩期间死亡。 怀孕和产后。产妇保健方面持续存在的种族和族裔差异， 已知的风险因素。尽管结构性种族主义被视为健康差距的根本原因， 一般来说，很少有研究（如果有的话）从经验上评估它在种族和民族之间过度SMM和死亡率中的作用， 少数民族生育的人。关于有效政策干预的证据-在州、地方和医院 在SMM/MM中解决SR的级别甚至更少。我们提出了一个严格的混合方法项目， 具体目标是：1）评估SR的多维指标与种族和民族差异的关联 在SMM中，自杀和死亡率;并估计归因于SR的SMM的医院费用; 2）评估 两个政策相关干预措施的关联（即，医疗补助资格慷慨和医疗保健工作人员 多样性）与SMM、自杀和死亡率的种族和民族差异;并量化调节效应 这两种干预措施之间的关联SR和孕产妇健康结果;和3）分析生活 患者、社区和医院利益相关者的经验，以确定有效的 解决方案，产妇保健中的SR。我们将分析一个强大的三角集的定量和定性 数据来自多个来源，捕捉国家和地方样本，并应用一套补充的 多层次建模，因果推理，扎根理论研究技术。医疗保健成本数据 该项目提供了21个州1200多家医院1000万例分娩的信息 在2016-2022年期间（目标1-2），将辅以前瞻性深入访谈和焦点小组数据， 纽约市三个医院所在地（布鲁克林， 华盛顿高地，皇后区）的重点为NY-CHAMP的干预项目2。目标1和2将测试 假设：1）SR的多维指数与显著增加的差异相关， SMM，自杀和死亡率; 2）更高的州医疗补助资格慷慨和医疗保健工作人员的多样性 与SMM、自杀倾向和死亡率的较低差异独立相关; 3）医疗补助资格 慷慨和卫生保健工作人员的多样性独立地减轻了SR对孕产妇死亡率差异的影响。 结果。目标3是假设生成。研究结果将有助于缩小我们对人类基因组的理解中的重要差距。 SR在SMM/MM差异中发挥的作用，并为多层次信息提供急需的证据 政策干预措施，以改善我们的城市，州和全国各地的孕产妇健康公平。

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.