R01NR020670

The effects of Medicaid policy interventions on racial equity in severe maternal morbidity - project summary/abstract

Rates of severe maternal morbidity (SMM) and mortality continue to rise in the US and have been exacerbated during the pandemic. The significant racial inequities in SMM and mortality are a public health crisis and are a result of historical and contemporary structural and social determinants including institutional and societal policies.

Integrating a racial equity lens to Medicaid policy interventions is a promising strategy for addressing the long-standing racial inequities in SMM and broadly in maternal health.

In the state of Pennsylvania, Medicaid is implementing policy interventions that explicitly focus on Black populations. Three policy interventions will be the focus of this study: the Equity Incentive Payment Program, the Equity-Focused Obstetric Care Bundled Payment Model, and the Reimbursement Program for Doula Services.

These policy interventions are critical but will not successfully address racial inequities without a multi-disciplinary, community-engaged process that involves a constant critical analysis for racial equity in the development and implementation of these policies.

We will conduct a multi-armed intervention study to assess the effects of the healthcare quality interventions (Equity Incentive Payment and Equity-Focused Obstetric Care Bundle) and the healthcare quality + doula care program vs. standard care.

Because these interventions are prospectively assigned to all PA Medicaid beneficiaries, we will compare within-state changes pre-post interventions, as well as comparing changes in outcomes pre-post interventions among PA Medicaid beneficiaries relative to Medicaid beneficiaries residing in similar states.

Our multidisciplinary team includes researchers and leaders across multiple academic institutions, the Medicaid Research Center, Healthy Start Inc, the Pennsylvania Doula Commission, and the Maternity Care Coalition.

Our study aims to:
1) Estimate the effect of Medicaid healthcare quality interventions on SMM.
2) Estimate the effect of Medicaid healthcare quality interventions + doula care.
3) Assess Medicaid beneficiaries' experiences in receiving services and the potential impact of integration of doula services and equity practices.

Our central hypothesis is that SMM rates will decline among Black populations after interventions relative to people of other racial groups.

This work will advance public health and health policy by implementing innovative methods to engage with Medicaid beneficiaries who are affected by health equity policies and provide quantitative estimates of the effects of health equity policy interventions on outcomes among Black pregnant and parenting people.

Results from this study will inform state and federal health policymakers considering structural policy interventions within Medicaid as a vehicle for addressing racial equity.

University Of Pittsburgh - Of The Commonwealth System Of Higher Education

NURSES UNDERSTAND THAT IMPROVING HEALTH AND WELL-BEING MEANS ADDRESSING PEOPLE'S NEEDS IN MULTIPLE SETTINGS, CONTEXTS, AND OVER THE WHOLE LIFE COURSE. SCIENCE SUPPORTED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) USES THIS HOLISTIC PERSPECTIVE TO IMPROVE INDIVIDUAL AND POPULATION HEALTH AND ADVANCE HEALTH EQUITY. NINR-SUPPORTED RESEARCH PROMOTES HEALTH AND WELL-BEING BY ADDRESSING NEEDS AT MULTIPLE LEVELS INDIVIDUAL, FAMILY, COMMUNITY, AND SOCIETAL LEVELS AND DEVELOPING TREATMENT AND PREVENTION STRATEGIES THAT ARE RESPONSIVE TO THE REALITY OF PEOPLE'S LIVES. NURSES KNOW PEOPLE, AND PEOPLE TRUST NURSES. PATIENT AND FAMILIES INTERACT WITH NURSES MORE THAN ANY OTHER CLINICIANS. NURSING SCIENCE USES THIS SPECIAL RELATIONSHIP TO BETTER UNDERSTAND PATIENTS, FAMILIES, AND COMMUNITIES AND THE MANY FACTORS THAT INFLUENCE THEIR HEALTH. NURSING SCIENCE SUPPORTED BY NINR USES THIS KNOWLEDGE TO DEVELOP STRATEGIES FOR IMPROVING HEALTH AND WELLNESS ACROSS POPULATIONS, HEALTH CARE SETTINGS, AND THE LIFESPAN, WITH AN EMPHASIS ON ACHIEVING HEALTH EQUITY. NINR-SUPPORTED SCIENTISTS HAVE DEVELOPED INTERVENTIONS FOR: SUPPORTING PARENTS OF PREMATURE INFANTS, PROMOTING HIV PREVENTION IN UNDERSERVED POPULATIONS, IMPROVING TRANSITIONAL CARE LEADING TO BETTER OUTCOMES AND COST-SAVINGS, AND HELPING INNER-CITY CHILDREN MANAGE ASTHMA. NURSING SCIENCE TRANSCENDS THE BOUNDARIES OF DISEASE AND RESEARCH DISCIPLINES TO BETTER UNDERSTAND THE EXPERIENCES OF INDIVIDUALS AND FAMILIES LIVING WITH ILLNESS AND TO DEVELOP PERSONALIZED APPROACHES THAT MAXIMIZE HEALTH AND WELL-BEING FOR INDIVIDUALS AT ALL STAGES OF LIFE, ACROSS DIVERSE POPULATIONS AND SETTINGS. NINR-SUPPORTED SCIENCE USES NURSING SCIENCE'S UNIQUE, PATIENT AND COMMUNITY-FOCUSED PERSPECTIVE AND WIDE REACH ACROSS CLINICAL AND COMMUNITY SETTINGS TO ADVANCE OUR UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH: THOSE FACTORS THAT ARE AT THE ROOT OF THE INEQUITIES THAT WE SEE, SUCH AS FOOD INSECURITY AND ACCESS TO HEALTHCARE. NINR RESEARCH EFFORTS IN WELLNESS INVESTIGATE THE KEY BIOLOGICAL, BEHAVIORAL, AND SOCIAL FACTORS THAT PROMOTE LONG-TERM HEALTH AND HEALTHY BEHAVIORS AND PREVENT THE DEVELOPMENT OF ILLNESS ACROSS HEALTH CONDITIONS, SETTINGS, AND THE LIFESPAN. RESEARCH IN WELLNESS IS ALSO FOCUSED ON DEVELOPING AND TESTING CULTURALLY APPROPRIATE INTERVENTIONS TO PROMOTE HEALTH AND PREVENT ILLNESS IN MINORITY AND UNDERSERVED GROUPS. NINR ALSO SUPPORTS SCIENCE TO ASSIST INDIVIDUALS, FAMILIES, AND HEALTH CARE PROFESSIONALS IN MANAGING ADVANCED, SERIOUS ILLNESS, AND PLANNING FOR END-OF-LIFE DECISIONS. IN ADDITION, NINR PROMOTES TECHNOLOGICAL ADVANCEMENTS THAT ADDRESS A RANGE OF HEALTH CARE CHALLENGES AND FACILITATE THE DELIVERY OF REAL-TIME PERSONALIZED INFORMATION TO INDIVIDUALS AND FAMILIES, HEALTH CARE PROVIDERS, AND COMMUNITIES. FINALLY, NINR HAS A LONGSTANDING AND CONTINUING COMMITMENT TO DEVELOPING THE NEXT GENERATION OF NURSE SCIENTISTS: THOSE INDIVIDUALS AND TEAM MEMBERS WHO WILL CARRY THE FIELD OF NURSING SCIENCE INTO THE FUTURE. IN ORDER TO PREPARE AN INNOVATIVE, DIVERSE, AND TALENTED NEXT GENERATION OF NURSE SCIENTISTS, NINR SUPPORTS A VARIETY OF TRAINING OPPORTUNITIES FOR SCIENTISTS AND TRAINEES AT ALL CAREER LEVELS, PARTICULARLY THOSE AT AN EARLY CAREER STAGE WHO ARE SO CRITICAL TO SUSTAINING THE FUTURE OF INNOVATIVE RESEARCH AND HIGH QUALITY HEALTH CARE.

93.361 - Nursing Research

National Institute of Nursing Research (NINR) [HHS - NIH]

Pennsylvania United States

State-Wide

Advancing Integrated Models (AIM) of Care to Improve Maternal Health Outcomes among Women Who Experience Persistent Disparities (R01 Clinical Trial Required) (RFA-NR-22-002)

Amendment Since initial award the total obligations have increased 290% from $793,582 to $3,092,243.