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| ID | Type | Description | Link |
|---|---|---|---|
| 1R01NR020670-01 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Nursing Research (NINR) | NIH |
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The goal of this study is to learn about the effects of structural inventions, such as equity-focused Medicaid polices, on severe maternal morbidity (SMM) and mortality and maternal health. The main questions it aims to answer are:
Participants will be asked to describe experiences as a result of structural interventions and focused Medicaid policies.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only | Other | The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates among Black people will decline after the interventions (equity payment and obstetric bundled payment), relative to people of other race groups within Pennsylvania (PA); and H2: Racial inequities in SMM will decline among those exposed to the interventions in PA, relative to those in similar states. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare interventions on beneficiaries' experiences. |
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| Doula Only | Other | The investigators will test two hypotheses: H1: SMM rates among Black people will decline more after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: Racial inequities in SMM will decline more among those exposed to both healthcare quality and doula care interventions in PA, relative to states implementing doula care only. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare and service interventions on beneficiaries' experiences. |
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| Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula | Other |
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| Standard Care |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) | Behavioral | This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2. 1) health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries |
| Measure | Description | Time Frame |
|---|---|---|
| Severe maternal morbidity (SMM) | SMM rate based on the Centers for Disease Control algorithm | 20 weeks gestation through 42 days postpartum |
| Measure | Description | Time Frame |
|---|---|---|
| All cause mortality | Binary indicator of mortality based on Social Security Administration records | Delivery date through one year after delivery |
| Follow up for chronic conditions | Percent of persons who receive guideline concordant care for depression, substance use disorders, immunizations, and screening and referral for social determinants of health |
| Measure | Description | Time Frame |
|---|---|---|
| Assess the changes in effects of the Medicaid healthcare quality interventions on beneficiaries' experiences | The investigators will collect qualitative data from three different study populations across Pennsylvania who will be affected by the Medicaid policies under study: 1) Medicaid beneficiaries (n=100; Years 2 and 4); 2) Doula care providers (n=60; Years 2 and 4); Managed Care Organization (MCO) leadership (n=10); Year 3 |
Inclusion Criteria:
Qualitative:
Exclusion Criteria:
-
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pittsburgh School of Public Health | Recruiting | Pittsburgh | Pennsylvania | 15261 | United States |
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Evaluation of policy interventions at the state level comparing within state and across states over time.
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| Doula | Behavioral | This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
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| Standard Care | Behavioral | Participants receive standard care without quality interventions or doula care |
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| 43 days through 1 year after delivery |
| Provision of evidence care in pregnancy and postpartum | Percent of Medicaid patients among each provider who receive screening and follow up for depression, treatment for substance use disorders, perinatal immunizations, and screening and referral for social determinants of health | During pregnancy and postpartum up to 1 year |
| Medicaid managed care administrator perspectives on policy interventions | Qualitative self report of perspectives | Year 3 |
| Years 2, 3, and 4 |
| ID | Term |
|---|---|
| D063130 | Maternal Death |
| ID | Term |
|---|---|
| D063129 | Parental Death |
| D003643 | Death |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D059037 | Doulas |
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D006282 | Health Personnel |
| D005159 | Health Care Facilities Workforce and Services |
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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