The Effects of Postpartum Medicaid Policies on Postpartum Depression Care Among Low-Income Women

项目摘要 本K 01的目标是为Sarah Gordon博士提供指导和培训，使其成为一名独立的 研究低收入人群获得心理健康服务的调查员。在全国，八分之一 妇女经历产后抑郁症（PPD）的症状，产后抑郁症的发病率是妇女的两倍， 参加医疗补助的妇女与参加商业保险的妇女相比。这项研究考察了 产后医疗补助资格和福利政策对产后护理低收入妇女使用两个阶段 解释性混合方法设计目标1和2将分析来自一个新的链接数据库的二级数据， 所有付款人索赔数据，出生证明和个人收入数据，符合NIMH的战略 目的是将来自多个来源的数据联合收割机结合起来，以确定服务不足的群体。使用回归 不连续性设计，目标1将评估在怀孕后保留医疗补助资格的影响- 产后60天PPD筛查、诊断和治疗率的相关合格性限制 产后一年目标2将使用差异中的差异方法来衡量医疗补助的效果 健康儿童就诊期间PPD筛查的报销， 产后一年，比较保持与失去医疗补助资格的妇女的结果 产后目标1和2将实施多层次建模技术，以检查县级主持人 的政策效果。在目标3中，我将对关键的政策知情人、提供者和患者进行定性访谈。 焦点小组探讨产后医疗补助政策如何影响PPD服务的获得。立意 定性抽样将由目标1和2中观察到的政策效果的县级主持人指导， PPD筛查和治疗率的ZIP代码级地理空间聚类分析。莎拉·戈登博士是一位 波士顿大学公共卫生学院助理教授。她有四个主要的培训目标：（1） 获得组织和提供心理健康服务的内容专业知识，重点是孕产妇 心理健康;（2）获得混合方法研究的技能;（3）发展定性数据收集的专业知识 和分析，以及（4）获得技能，以衡量和地图的政策效果的地区层面的变化。产后 心理健康问题是可预防的产后产妇发病和死亡的主要原因。的 该提案的目的是检查医疗补助政策的效果，以增加发现和治疗 产后抑郁症，从而改善产后心理健康。这项研究符合NIMH的高优先级研究 妇女围产期心理健康领域，并响应国家精神卫生战略计划 优先加强NIMH研究的公共卫生影响，通过测试减少经验的方法， 社会经济处境不利者在获得护理方面存在有据可查的差距。

PROJECT SUMMARY This goal of this K01 is to provide the mentorship and training for Dr. Sarah Gordon to become an independent investigator studying access to mental health services among low-income populations. Nationally, 1 in 8 women experience symptoms of postpartum depression (PPD), and rates of PPD are twice as high among women enrolled in Medicaid compared to commercially-insured women. This research examines the effects of postpartum Medicaid eligibility and benefit policies on PPD care among low-income women using a two-phase explanatory mixed-methods design. Aims 1 and 2 will analyze secondary data from a novel linked database of all payer claims data, birth certificates, and individual-level income data, consistent with NIMH's strategic objective to combine data from multiple sources to identify underserved groups. Using a regression discontinuity design, Aim 1 will evaluate the effects of retaining Medicaid eligibility beyond the pregnancy- related eligibility limit of 60 days postpartum on PPD screening, diagnosis, and treatment rates in the postpartum year. Aim 2 will use a difference-in-differences approach to measure the effects of Medicaid reimbursement for PPD screening during well-child visits on PPD screening, diagnosis, and treatment rates in the postpartum year, comparing outcomes among women who maintain versus lose Medicaid eligibility postpartum. Aims 1 and 2 will implement multi-level modeling techniques to examine county-level moderators of policy effects. In Aim 3, I will conduct qualitative interviews with key policy informants, providers, and patient focus groups to explore how postpartum Medicaid policies impact access to PPD services. Purposive qualitative sampling will be guided by county-level moderators of policy effects observed in Aims 1 and 2 and a ZIP-code level geospatial cluster analysis of PPD screening and treatment rates. Dr. Sarah Gordon is an assistant professor at the Boston University School of Public Health. She has four key training objectives: (1) acquire content expertise in the organization and delivery of mental health services, with a focus on maternal mental health; (2) obtain skills in mixed-methods research; (3) develop expertise in qualitative data collection and analysis, and (4) acquire skills to measure and map area-level variation in policy effects. Postpartum mental health conditions are a leading cause of preventable postpartum maternal morbidity and mortality. The goal of this proposal is to examine the effects of Medicaid policies in order to increase detection and treatment of PPD, thereby improving postpartum mental health. This research aligns with NIMH's high priority research area on women's mental health during the perinatal period and is responsive to the NIMH Strategic Plan priority to strengthen the public health impact of NIMH research by testing approaches for reducing empirically documented disparities in care access for socioeconomically disadvantaged persons.