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Principal Investigator: Marian Patricia Jarlenski
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $763,485
Funding agency: National Institute of Nursing Research
Project Summary/Abstract
Rates of severe maternal morbidity (SMM) and mortality continue to rise in the US and have
been exacerbated during the pandemic. The significant racial inequities in SMM and mortality
are a public health crisis and are a result of historical and contemporary structural and social
determinants including institutional and societal policies. Integrating a racial equity lens to
Medicaid policy interventions is a promising strategy for addressing the long-standing racial
inequities in SMM and broadly in maternal health. In the state of Pennsylvania, Medicaid is
implementing policy interventions that explicitly focus on Black populations. Three policy
interventions will be the focus of this study: the equity incentive payment program, the equity-
focused obstetric care bundled payment model and the reimbursement program for doula
services. These policy interventions are critical but will not successfully address racial inequities
without a multi-disciplinary, community engaged process that involves a constant critical
analysis for racial equity in the development and implementation of these policies. We will
conduct a multi-armed intervention study to assess the effects of the healthcare quality
interventions (equity incentive payment and equity-focused obstetric care bundle) and the
healthcare quality + doula care program vs. standard care. Because these interventions are
prospectively assigned to all PA Medicaid beneficiaries, we will compare within-state changes
pre-post interventions, as well as comparing changes in outcomes pre-post interventions among
PA Medicaid beneficiaries relative to Medicaid beneficiaries residing in similar states. Our
multidisciplinary team includes researchers and leaders across multiple academic institutions,
the Medicaid Research Center, Healthy Start Inc, the Pennsylvania Doula Commission and the
Maternity Care Coalition. Our study aims to: 1) estimate the effect of Medicaid healthcare quality
interventions on SMM, 2) estimate the effect of Medicaid healthcare quality interventions +
doula care, 3) Assess Medicaid beneficiaries’ experiences in receiving services and the
potential impact of integration of doula services and equity practices. Our central hypothesis is
that SMM rates will decline among Black populations after interventions relative to people of
other racial groups. This work will advance public health and health policy by implementing
innovative methods to engage with Medicaid beneficiaries who are affected by health equity
policies and provide quantitative estimates of the effects of health equity policy interventions on
outcomes among Black pregnant and parenting people. Results from this study will inform state
and federal health policymakers considering structural policy interventions within Medicaid as a
vehicle for addressing racial equity.
Terms: <Address><Adoption><Affect><Assess implementation><Birth><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Child Rearing><Chronic><Data><Development><Discipline of obstetrics><Equity><Exposure to><Focus Groups><Foundations><Funding><Gestation><Goals><Health><Health Policy><Healthcare><Implementation assessment><Improve Access><Incentives><Inequity><Institution><Intervention><Intervention Strategies><Intervention Studies><Interview><Investigators><Low Income Population><Low income group><Managed Care><Maternal Health><Maternal Mortality><Medicaid><Medicaid services><Methods><Modeling><Obstetrics><Outcome><Parenting><Parenting behavior><Parturition><Pennsylvania><Personal Satisfaction><Persons><Phase><Police><Policies><Policy Maker><Population><Postpartum Period><Pregnancy><Prenatal care><Public Health><QOC><Qualitative Research><Quality of Care><Race><Races><Racial Equity><Racial Group><Research><Research Personnel><Research Resources><Researchers><Resources><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Source><Supportive Therapy><Supportive care><United States><Wood><Wood material><Work><after pregnancy><beneficiary><bundled payment><care services><care systems><childrearing><community engagement process><community partners><community-based partners><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><developmental><disparities in race><disparity due to race><evaluate implementation><evaluation of implementation><experience><health care><health care policy><health care quality><health equity><healthcare policy><healthcare quality><implementation evaluation><improved><inequality due to race><inequity due to race><innovate><innovation><innovative><integrated care><integrated model of care><intervention research><interventional research><interventional strategy><interventional study><interventions research><invention><lens><lenses><low income individual><low income people><maternal death><maternal morbidity><multidisciplinary><obstetric care><pandemic><pandemic disease><payment><post intervention><post pregnancy><post-partum><pregnancy care><pregnancy health><pregnant><prenatal appointment><prenatal checkup><prenatal visit><programs><prospective><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially unequal><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe maternal morbidity><social><social determinants><sociodeterminant><standard care><standard treatment><structural determinants><structural factors><well-being><wellbeing>