The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity
- Conditions
- Maternal DeathSevere Maternal Morbidity
- Interventions
- Behavioral: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)Behavioral: DoulaBehavioral: Standard Care
- Registration Number
- NCT05678699
- Lead Sponsor
- University of Pittsburgh
- Brief Summary
The goal of this study is to learn about the effects of structural inventions, such as equity-focused Medicaid polices, on severe maternal morbidity (SMM) and mortality and maternal health. The main questions it aims to answer are:
1. What is the effect of Medicaid healthcare quality interventions on SMM?
2. What is the effect of Medicaid healthcare quality interventions + doula care?
3. What are Medicaid beneficiaries' experiences in receiving services and the potential impact of integration of doula services and equity practices?
Participants will be asked to describe experiences as a result of structural interventions and focused Medicaid policies.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 10000000
- Pregnant and postpartum Medicaid beneficiaries across the US
Qualitative:
- Medicaid beneficiaries who self-identify as Black and/or live in PA Health Equity Zones
- Doulas who provide care to Medicaid beneficiaries in Pennsylvania
- Medicaid Managed Care Organization (MCO) administrators in Pennsylvania. Severe maternal morbidity and mortality outcomes will be assessed in healthcare records and for these quantitative outcomes, patients will not be recruited individually
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) - Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula Standard Care - Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula Doula - Doula Only Standard Care The investigators will test two hypotheses: H1: SMM rates among Black people will decline more after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: Racial inequities in 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. Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates among Black people will decline after the interventions (equity payment and obstetric bundled payment), relative to people of other race groups within Pennsylvania (PA); and H2: Racial inequities in 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. Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only Standard Care The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates among Black people will decline after the interventions (equity payment and obstetric bundled payment), relative to people of other race groups within Pennsylvania (PA); and H2: Racial inequities in 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. Doula Only Doula The investigators will test two hypotheses: H1: SMM rates among Black people will decline more after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: Racial inequities in 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.
- Primary Outcome Measures
Name Time Method Severe maternal morbidity (SMM) 20 weeks gestation through 42 days postpartum SMM rate based on the Centers for Disease Control algorithm
- Secondary Outcome Measures
Name Time Method Medicaid managed care administrator perspectives on policy interventions Year 3 Qualitative self report of perspectives
Follow up for chronic conditions 43 days through 1 year after delivery Percent of persons who receive guideline concordant care for depression, substance use disorders, immunizations, and screening and referral for social determinants of health
Provision of evidence care in pregnancy and postpartum During pregnancy and postpartum up to 1 year Percent of Medicaid patients among each provider who receive screening and follow up for depression, treatment for substance use disorders, perinatal immunizations, and screening and referral for social determinants of health
All cause mortality Delivery date through one year after delivery Binary indicator of mortality based on Social Security Administration records
Trial Locations
- Locations (1)
University of Pittsburgh School of Public Health
🇺🇸Pittsburgh, Pennsylvania, United States