Disparities in utilization and delivery outcomes for women with perinatal mood and anxiety disorders (PMAD): groundwork for state policymaking

项目概要/摘要 本研究直接响应NIMHD少数民族卫生服务研究项目公告 健康和健康差异（PAR-20 - 310）。围产期情绪和焦虑障碍（PMAD），包括 分娩前和/或分娩后一年的抑郁和/或焦虑，是常见的妊娠并发症， 影响多达四分之一的女性，在美国每年花费超过150亿美元。PMAD可能会对 母亲，婴儿和家庭超过围产期，并具有持久的临床和经济影响。pmad 治疗可以改善孕产妇和新生儿的健康结果，但很少使用心理健康服务。 没有全面的数据来源记录：1）幅度，2）预测因素，3）差异的变化， 种族和民族、社会经济地位和医疗保健利用或产科分娩结局的地理位置 在PMAD患者中几乎没有证据证明社区特征对这些的影响。 成果。目前还没有关于如何最好地解决PMAD的国家计划，总体上，或在高风险亚组。 使用来自公共（医疗补助）和私人（Optum）保险的PMAD妇女的数据，州调查数据， 来自围产期心理健康服务和政策专家小组的意见，以及与州孕产妇和 婴儿健康（MIH）和MH政策制定者，我们将：1）确定患者水平的临床特征 与MH和总体围产期利用率和分娩相关结局相关， 妇女与诊断PMAD，并建立准确的国家和国家一级的估计， 护理模式和结果的差异，包括MH利用率、总体利用率，以及 分娩结局; 2）确定社区一级特征对围产期 使用来自妊娠风险数据的PMAD妇女的使用和分娩结局 评估监测系统（PRAMS）、地区卫生资源档案（AHRF）和国家精神卫生 服务调查（N-MHSS）;以及3）与专家小组合作， PMAD的决策指南，我们将使用它来采访国家孕产妇和婴儿健康 和精神卫生政策官员。利用目标1 - 2的研究结果和专家小组的意见，我们将制定一个EBP PMAD指南。本指南将提供与国家孕产妇和婴儿健康访谈的结构， 来自PMAD治疗相对表现较高和较低的州的心理健康政策官员， 结果有助于解释定量结果，定制建议，并协助未来的PMAD 决策举措。 鉴于缺乏对解决PMAD和相关利用和交付方面的差异的研究， 结果，和高，代际成本的母亲和婴儿的管理不善PMAD，这 创新的大规模调查将为未来的决策和临床干预提供证据。我们 研究结果和政策指导可以解决高成本、高风险亚群体的结果差异问题。

Project Summary/Abstract This study directly responds to NIMHD Program Announcement for Health Services Research on Minority Health and Health Disparities (PAR-20-310). Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four women, with costs over $15 billion per year in the US. PMAD can negatively affect mothers, babies, and families beyond the perinatal period, and have lasting clinical and economic effects. PMAD treatment can improve maternal and neonatal health outcomes, yet mental health services are rarely used. No comprehensive data source documents the: 1) magnitude, 2) predictors, and 3) variation in disparities by race and ethnicity, socioeconomic status, and geography in healthcare utilization or obstetric delivery outcomes among women with PMAD. Almost no evidence documents the impact of community characteristics on these outcomes. There is no national plan for how best to address PMAD, overall, or within high-risk subgroups. Using data from publicly (Medicaid) and privately (Optum) insured women with PMAD, state survey data, input from a panel of perinatal mental health services and policy experts, and interviews with state maternal and infant health (MIH) and MH policy makers, we will: 1) identify patient-level clinical characteristics associated with MH and overall perinatal utilization and delivery-related outcomes among women with diagnosed PMAD, and establish accurate national and state-level estimates of disparities in care patterns and outcomes, including MH utilization, overall utilization, and delivery-outcomes; 2) determine contributions of community-level characteristics to perinatal utilization and delivery outcomes among women with PMAD using data from Pregnancy Risk Assessment Monitoring System (PRAMS), Area Health Resource File (AHRF), and National Mental Health Services Survey (N-MHSS); and 3) collaborate with an expert panel to develop an evidence-based policymaking guide for PMAD, which we will use to interview state maternal and infant health and mental health policy officials. Using Aim 1-2 findings and expert panel input, we will develop an EBP guide for PMAD. This guide will provide structure for interviews with state maternal and infant health and mental health policy officials from states with high and low relative performance on PMAD treatment and outcomes to help interpret quantitative findings, tailor recommendations, and assist in future PMAD policymaking initiatives. Given the dearth of research on disparities in addressing PMAD and associated utilization and delivery outcomes, and the high, inter-generational costs for mother and baby of ineffectively managed PMAD, this innovative, large-scale investigation will provide evidence for future policymaking and clinical interventions. Our findings and policy guidance could address disparities in outcomes for high cost, high risk subpopulations.