Minding the gap: a multidisciplinary approach to reducing maternal health disparities in Georgia

项目总结 美国的孕产妇死亡率(每10万个活产中有26.4个孕产妇死亡)是发达国家中最高的 各国之间的差异很大，不同国家和种族/族裔群体之间的差异很大。乔治亚州是第二个 最高的孕产妇死亡率(66.3/100,000)，黑人妇女比白人妇女的死亡率高60%(95.6比59.7 每100,000)。然而，严重的孕产妇发病率几乎是产妇死亡率的100倍。 (SMM)。在黑人、公共保险或未参保的妇女中，孕产妇死亡率和SMM最高， 并在安全网医院分娩。在佐治亚州，近三分之二的孕产妇死亡和SMM被认为 可预防的，慢性健康状况、肥胖、获取延迟和护理分散是关键 贡献者。目前的数据表明，产后SMM的增长速度快于SMM 分娩住院治疗。格鲁吉亚孕产妇健康危机的拟议解决方案包括改善产前 和产后跟踪和病例管理，控制慢性健康状况，并延长 医疗补助覆盖范围。然而，关于这些策略是否能够改善，缺乏证据。 产妇保健或减少SMM或死亡率方面的种族差异。拟议的研究将开始填补这一空白。 采用多学科、混合方法的方法。我们将首先分析佐治亚州的重要记录，医院 释放和索赔数据，以提供差异的程度、位置和决定因素的概览 非西班牙裔黑人和非西班牙裔白人妇女分娩时和产后3至12个月的SMM。 使用基于回归的分解方法，我们将突出种族/民族差异的部分 用可观察和不可观察的因素来解释。我们将利用这些发现和对 产后妇女及其保健提供者和病例管理人员对两个案例的分析 针对有不良后果风险的妇女的产后干预--现有的医疗补助政策和 新设计的卫生系统干预措施。佐治亚州健康婴儿医疗补助计划(P4HB) 医疗补助计划为产后妇女提供极低出生体重的分娩初级保健，包括 护士病例管理和母亲资源外展，将妇女与社会支持联系起来。这项研究将是 第一个评估这项医疗补助政策对SMM差异的影响。然后这些分析将被用于 向在亚特兰大一家安全网医院分娩的妇女介绍新的产后护理系统的设计， 佐治亚州，并面临更大的SMM风险。女性(N=320)将随机分配到这两组中的一组 增强的产后护理系统与标准护理相比，在12周内和12周内评估结果 产后几个月，包括产后护理就诊、接受推荐护理和不良反应 结果，如重新入院。从拟议的工作中获得的见解将填补批判性知识 在减少孕产妇健康差距的政策和做法方面存在差距，可以作为 为该州和全国未来的预防和干预战略奠定基础。

PROJECT SUMMARY The US maternal mortality ratio (26.4 maternal deaths per 100,000 livebirths) is the highest among developed nations, with wide variation across states and racial/ethnic groups. The state of Georgia has the second highest maternal mortality (66.3 per 100,000), with a 60% higher rate for black vs white women (95.6 vs 59.7 per 100,000). Nearly 100 times more common than maternal mortality, however, is severe maternal morbidity (SMM). Maternal mortality and SMM are highest among women who are black, publicly insured or uninsured, and deliver in safety-net hospitals. In Georgia, nearly two-thirds of maternal deaths and SMM are deemed preventable, with chronic health conditions, obesity, delays in accessing and fragmentation of care as key contributors. Current data indicate that postpartum SMM is increasing at a faster rate than SMM during the delivery hospitalization. Proposed solutions to the maternal health crisis in Georgia include improved prenatal and postpartum follow-up and case management, control of chronic health conditions, and extension of Medicaid coverage. However, there is a dearth of evidence regarding whether such strategies can improve maternal health or reduce racial disparities in SMM or mortality. The proposed study will begin to fill this void with a multidisciplinary, mixed-methods approach. We will first analyze Georgia linked vital records, hospital discharge, and claims data to provide an overview of the extent, location and determinants of differences in SMM among non-Hispanic black and non-Hispanic white women at delivery and 3 to 12 months postpartum. Using regression-based decomposition methods we will highlight the portions of the racial/ethnic differences explained by observable and unobservable factors. We will use these findings and in-depth interviews with postpartum women and their health care providers and case managers to contextualize the analysis of two postpartum interventions targeting women at risk for adverse outcomes – an existing Medicaid policy and a newly designed health system intervention. The Georgia Medicaid Planning for Healthy Babies (P4HB) Medicaid program provides postpartum women with a very low birth weight delivery primary care inclusive of nurse case management and Resource Mother outreach to link women to social supports. This study will be the first to evaluate the effects of this Medicaid policy on SMM disparities. These analyses will then be used to inform the design of the new postpartum care system for women who deliver at a safety-net hospital in Atlanta, Georgia, and are at increased risk for SMM. Women (N = 320) will be randomly assigned to either this enhanced postpartum care system vs. standard care, with assessment of outcomes within 12 weeks and 12 months postpartum, including attendance of postpartum care visits, receipt of recommended care, and adverse outcomes such as hospital readmissions. The insights gained from the proposed work will fill critical knowledge gaps regarding policy and practice approaches for reducing maternal health disparities and can serve as a foundation for future prevention and intervention strategies within the state and nationally.