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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

基本信息

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
项目类别：
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

项目摘要

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、长期目标是为改善人口孕产妇状况的努力提供信息通过了解和解决种族和民族差异的根本决定因素来实现健康公平严重的孕产妇发病率（SMM）和死亡率（MM），并确保公平获得优质、文化的服务适当的孕产妇保健。美国少数种族和族裔出生人数约为美国的三倍非西班牙裔白人分娩者可能会经历危及生命的并发症并在分娩过程中死亡怀孕和产后。孕产妇健康方面持续存在的种族和民族差异并没有得到充分解释已知的风险因素。尽管结构性种族主义（SR）被视为健康差异的根本原因一般来说，很少有研究（如果有的话）实证评估它在种族和群体中过度 SMM 和死亡率中的作用。少数民族出生的人。关于州、地方和医院有效政策干预的证据级别——在 SMM/MM 中解决 SR 的情况则更加缺乏。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 多维指数与种族和民族差异的关联 SMM、自杀倾向和死亡率；并估算因 SR 导致的 SMM 住院费用； 2）评估两项政策相关干预措施（即医疗补助资格的慷慨程度和医疗保健劳动力）的关联多样性）在 SMM、自杀率和死亡率方面存在种族和民族差异；并量化调节作用这两种干预措施对 SR 和孕产妇健康结果之间关系的影响； 3）分析生活患者、社区和医院利益相关者的经验，以确定机制和有效的孕产妇保健中的 SR 解决方案。我们将分析一组稳健的定量和定性三角测量来自多个来源的数据，捕获国家和地方样本，并应用一套补充的多层次建模、因果推理和扎根理论研究技术。医疗费用数据和利用项目，提供 21 个州 1200 多家医院的 1000 万例分娩信息 2016-2022 年期间（目标 1-2），将得到来自以下机构的前瞻性深入访谈和焦点小组数据的补充：纽约市三个医院地点（布鲁克林、皇后区华盛顿高地）是 NY-CHAMP 干预项目 2 的重点。目标 1 和 2 将测试假设：1）SR 的多维指数与显着增加的差异相关 SMM、自杀率和死亡率； 2) 更高的州医疗补助资格和医疗保健劳动力多样性与 SMM、自杀率和死亡率的较低差异独立相关； 3) 医疗补助资格慷慨和医疗保健劳动力多样性独立减轻了 SR 对孕产妇差异的影响结果。目标 3 将生成假设。研究结果将有助于弥合我们理解上的重要差距 SR 在 SMM/MM 差异中发挥的作用，并生成为多层次提供信息所急需的证据旨在改善我们市、州和全国孕产妇健康公平的政策干预措施。