중증 산모 이환율에 대한 Medicaid 정책 개입이 인종 형평성에 미치는 영향

간섭 없음: 스탠다드 케어

다른: 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.

행동: 스탠다드 케어

참가자는 품질 개입 또는 둘라 케어 없이 표준 케어를 받습니다.

행동: 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.

다른: 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.

행동: 스탠다드 케어

참가자는 품질 개입 또는 둘라 케어 없이 표준 케어를 받습니다.

행동: 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.

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

행동: 스탠다드 케어

참가자는 품질 개입 또는 둘라 케어 없이 표준 케어를 받습니다.

행동: 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.

행동: 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.

중증 산모 이환율(SMM)

질병 통제 센터 알고리즘에 기반한 SMM 속도

모든 원인 사망

사회 보장국 기록을 기반으로 한 사망률의 바이너리 지표

만성 질환에 대한 후속 조치

우울증, 약물 사용 장애, 예방 접종, 건강의 사회적 결정 요인에 대한 선별 및 위탁에 대한 가이드라인 일치 치료를 받는 사람의 비율

임신 및 산후 관리의 증거 제공

우울증에 대한 선별검사 및 후속 조치, 약물 사용 장애 치료, 주산기 예방접종, 건강의 사회적 결정요인에 대한 선별검사 및 위탁을 받는 각 제공자 중 Medicaid 환자의 비율

정책 개입에 대한 Medicaid 관리 의료 관리자의 관점

관점의 질적 자기보고

수혜자의 경험에 대한 Medicaid 의료 품질 개입의 영향 변화를 평가합니다.

조사관은 연구 중인 Medicaid 정책의 영향을 받을 펜실베니아 전역의 세 가지 다른 연구 모집단으로부터 정성적 데이터를 수집할 것입니다. 1) Medicaid 수혜자(n=100; 2년 및 4년); 2) 둘라 케어 제공자(n=60; 2년차 및 4년차); 관리 의료 조직(MCO) 리더십(n=10); 3학년