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的努力提供努力通过理解和解决基础种族和种族分配的基本确定，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质量适当的母校医疗保健。美国的种族和种族少数生日的人约为可能是非西班牙裔白人生日的人会经历威胁生命的并发症，并在怀孕和产后。孕产妇健康中持续的种族和种族差异并未完全解释已知风险因素。尽管结构性种族主义（SR）被视为健康差异的基本原因通常，很少有研究（如果有的话）在经验上评估了IT在过多的SMM和种族和死亡率中的作用少数民族分娩的人。有关有效政策干预措施的证据 - 在州，地方和医院级别 - 在SMM/mm中解决SR的问题更少。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多维指数与种族和种族差异的关联在SMM中，自杀和死亡率；并估计SR可归因于SMM的医院费用； 2）评估两项与政策相关的干预措施的协会（即医疗补助资格慷慨和医疗保健劳动力多样性）在SMM，自杀和死亡率中具有种族和种族差异；并量化调节效果在这两种有关SR与孕产妇健康结果之间关联的干预措施中； 3）分析生活患者，社区和医院利益相关者的经验，以确定和有效的机制孕产妇医疗保健中的SR解决方案。我们将分析一组强大的三角定量和定性集来自多个来源的数据，同时捕获国家和当地样本，并应用一套完整的套件多级建模，因果推断和扎根理论研究技术。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个州的1200多家医院的1000万儿童外生的信息在2016 - 2022年（目标1-2）期间，将通过潜在的深入面试和重点小组数据完成纽约市三个医院现场的多部门利益相关者（患者，社区，医院）（布鲁克林，华盛顿高地，皇后区的纽约 - 坎普干预项目2。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有关 SMM，自杀和死亡率； 2）较高的州医疗补助资格慷慨和医疗保健劳动力多样性与SMM，自杀和死亡率中的分布较低相关； 3）医疗补助资格慷慨和医疗保健劳动力多样性独立地减轻了SR对孕产妇分布的影响结果。目标3将是假设产生的。调查结果将有助于弥合我们对的理解 SR在SMM/MM差异中扮演的角色，并迫切需要证据以告知多层次政策干预措施，以改善我们城市，州和全国的孕产妇健康公平。