PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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 ).
METHODS: 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.
CONCLUSIONS: 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 ).
摘要：
背景：严重孕产妇发病率（SMM）和死亡率的种族不平等构成了美国的公共卫生危机。杜拉护理，定义为提供文化上适当的分娩工人的护理，怀孕和产后期间的非临床支持，已被提议作为一种干预措施，以帮助破坏产科种族主义，这是黑人和其他有色人种分娩者不良妊娠结局的驱动因素。许多州医疗补助计划正在实施doula计划，以解决SMM和死亡率的持续增加。医疗补助计划有望在满足这些人群的需求方面发挥重要作用，以缩小SMM和死亡率方面的种族差距。这项研究将调查医疗补助计划可以实施导乐护理以改善种族健康公平的最有效方法。
方法：我们描述了一项混合方法研究的方案，以了解医疗补助中doula计划的实施变化如何影响怀孕和产后健康的种族平等。主要研究结果包括SMM，个人报告的尊重产科护理措施，和接受循证护理的慢性疾病是产后死亡的主要原因（心血管，心理健康,和物质使用条件)。我们的研究小组包括Doulas,大学调查人员,和来自六个地点的医疗补助参与者(肯塔基州，马里兰,密歇根州,宾夕法尼亚,南卡罗来纳州和弗吉尼亚州）在医疗补助成果分布式研究网络（MODRN）中。研究数据将包括对导拉计划实施的政策分析，来自一群Doulas的纵向数据，来自医疗补助受益人的横截面数据，和医疗补助医疗管理数据。定性分析将检查doula和受益人在医疗保健系统和医疗补助政策方面的经验。定量分析（按种族组分层）将使用匹配技术来估计使用导乐护理对产后健康结果的影响，并将使用时间序列分析来估计doula计划对人口产后健康结果的平均治疗效果。
结论：研究结果将促进医疗补助计划中的学习机会，doulas和医疗补助受益人。最终,我们寻求了解doula护理计划的实施和整合到医疗补助中，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）注册。IO/NXZUF）。
方法：我们描述了一项混合方法研究的方案，以了解医疗补助中doula计划的实施变化如何影响怀孕和产后健康的种族平等。主要研究结果包括SMM，个人报告的尊重产科护理措施，和接受循证护理的慢性疾病是产后死亡的主要原因（心血管，心理健康,和物质使用条件)。我们的研究小组包括Doulas,大学调查人员,和来自六个地点的医疗补助参与者(肯塔基州，马里兰,密歇根州,宾夕法尼亚,南卡罗来纳州和弗吉尼亚州）在医疗补助成果分布式研究网络（MODRN）中。研究数据将包括对导拉计划实施的政策分析，来自一群Doulas的纵向数据，来自医疗补助受益人的横截面数据，和医疗补助医疗管理数据。定性分析将检查doula和受益人在医疗保健系统和医疗补助政策方面的经验。定量分析（按种族组分层）将使用匹配技术来估计使用导乐护理对产后健康结果的影响，并将使用时间序列分析来估计doula计划对人口产后健康结果的平均治疗效果。
结论：研究结果将促进医疗补助计划中的学习机会，doulas和医疗补助受益人。最终,我们寻求了解doula护理计划的实施和整合到医疗补助中，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）注册。IO/NXZUF）。
