重度の母親の罹患率における人種的平等に対するメディケイド政策介入の影響

介入なし：標準ケア

他の：Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment) Only

The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates will decline among populations at risk after the interventions (incentive payment and obstetric bundled payment) within Pennsylvania (PA); and H2: 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.

行動：標準ケア

参加者は、質の高い介入やドゥーラケアなしで標準的なケアを受けます

行動：Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment)

This study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2.

1) incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes.

他の：Doula Only

The investigators will test two hypotheses: H1: SMM rates will decline among populations at risk after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: 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.

行動：標準ケア

参加者は、質の高い介入やドゥーラケアなしで標準的なケアを受けます

行動：Doula

This study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2.

1. Incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes.
2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.

他の：Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment) + Doula

行動：標準ケア

参加者は、質の高い介入やドゥーラケアなしで標準的なケアを受けます

行動：Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment)

This study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2.

1) incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes.

行動：Doula

This study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2.

1. Incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes.
2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.

重度の母体罹患率（SMM）

Centers for Disease Control アルゴリズムに基づく SMM 率

すべての原因の死亡率

社会保障庁の記録に基づく死亡率のバイナリ指標

慢性疾患のフォローアップ

うつ病、物質使用障害、予防接種、および健康の社会的決定要因のスクリーニングと紹介について、ガイドラインに準拠したケアを受けている人の割合

妊娠中・産後のエビデンスケアの提供

うつ病のスクリーニングとフォローアップ、物質使用障害の治療、周産期の予防接種、健康の社会的決定要因のスクリーニングと紹介を受けた各医療提供者のメディケイド患者の割合

政策介入に関するメディケイドマネージドケア管理者の視点

視点の質的自己報告

受益者の経験に対するメディケイド医療の質の介入の効果の変化を評価する

調査員は、調査中のメディケイド ポリシーの影響を受けるペンシルベニア州の 3 つの異なる調査対象集団から定性的データを収集します。 2) ドゥーラケア提供者 (n=60; 2 年目と 4 年目);マネージド ケア オーガニゼーション (MCO) のリーダーシップ (n=10); 3年目