医疗补助政策干预对严重孕产妇发病率种族平等的影响

无干预：标准护理

其他：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.

行为的：标准护理

参与者在没有质量干预或导乐护理的情况下接受标准护理

行为的：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.

其他：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.

行为的：标准护理

参与者在没有质量干预或导乐护理的情况下接受标准护理

行为的：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.

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

行为的：标准护理

参与者在没有质量干预或导乐护理的情况下接受标准护理

行为的：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.

行为的：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.

严重孕产妇发病率 (SMM)

基于疾病控制中心算法的 SMM 率

全因死亡率

基于社会保障管理局记录的死亡率二元指标

跟进慢性病

在抑郁症、物质使用障碍、免疫接种以及健康问题社会决定因素筛查和转诊方面接受指南协调护理的人数百分比

在怀孕和产后提供循证护理

每个提供者中接受抑郁症筛查和跟进、物质使用障碍治疗、围产期免疫接种以及健康社会决定因素筛查和转诊的医疗补助患者百分比

医疗补助管理式医疗管理员对政策干预的看法

观点的定性自我报告

评估医疗补助医疗保健质量干预措施对受益人体验的影响变化

研究人员将从宾夕法尼亚州的三个不同研究人群中收集定性数据，他们将受到所研究的医疗补助政策的影响：1) 医疗补助受益人（n=100；第 2 年和第 4 年）； 2) 导乐护理人员（n=60；第 2 年和第 4 年）；管理式医疗组织 (MCO) 领导层 (n=10)；三年级