Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, Pittsburgh, PA, 15261, United States of America.
Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
Health Res Policy Syst. 2024 Aug 8;22(1):98. doi: 10.1186/s12961-024-01185-9.
Racial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity.
We describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes.
Findings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity. Study registration The study is registered with the Open Science Foundation ( https://doi.org/10.17605/OSF.IO/NXZUF ).
在美国，严重产妇发病率（SMM）和死亡率方面的种族不平等现象构成了公共卫生危机。导乐护理的定义是指在怀孕和产后期间，由提供文化上合适、非临床支持的生育工作者提供的护理，它已被提议作为一种干预措施，以帮助打破产科种族主义，因为它是导致黑人及其他有色人种产妇不良妊娠结局的一个驱动因素。许多州的医疗补助计划正在实施导乐项目，以应对 SMM 和死亡率的持续上升。医疗补助计划有望在满足这些人群的需求方面发挥主要作用，目标是缩小 SMM 和死亡率方面的种族差距。本研究将探讨医疗补助计划实施导乐护理以改善种族健康公平的最有效方法。
我们描述了一项混合方法研究的方案，以了解医疗补助计划中导乐项目实施的差异如何影响妊娠和产后健康的种族公平。主要研究结果包括 SMM、尊重产科护理的个人报告措施，以及为产后死亡率的主要原因（心血管、心理健康和物质使用状况）的慢性疾病提供循证护理。我们的研究团队包括导乐、大学研究人员以及来自 Medicaid Outcomes Distributed Research Network（MODRN）的六个地点（肯塔基州、马里兰州、密歇根州、宾夕法尼亚州、南卡罗来纳州和弗吉尼亚州）的 Medicaid 参与者。研究数据将包括对导乐项目实施情况的政策分析、来自一组导乐的纵向数据、来自 Medicaid 受益人的横断面数据以及 Medicaid 医疗保健管理数据。定性分析将检查导乐和受益人与医疗保健系统和 Medicaid 政策的经验。定量分析（按种族群体分层）将使用匹配技术估计使用导乐护理对产后健康结果的影响，并使用时间序列分析估计导乐计划对人群产后健康结果的平均治疗效果。
研究结果将为 Medicaid 计划、导乐和 Medicaid 受益人群提供学习机会。最终，我们旨在了解导乐护理计划在 Medicaid 中的实施和整合情况，以及这些过程如何影响种族健康公平。研究注册 该研究在开放科学基金会（https://doi.org/10.17605/OSF.IO/NXZUF）注册。
