Maternal Death, Severe Maternal Morbidity
Conditions
Brief summary
The goal of this study is to learn about the effects of Medicaid policy interventions 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? Participants will be asked to describe experiences as a result of Medicaid policy interventions and focused Medicaid policies.
Interventions
BEHAVIORALMedicaid 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.
BEHAVIORALDoula
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.
BEHAVIORALStandard Care
Participants receive standard care without quality interventions or doula care
Sponsors
University of Pittsburgh
National Institute of Nursing Research (NINR)
Study design
Allocation
NON_RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Evaluation of policy interventions at the state level comparing within state and across states over time.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Pregnant and postpartum Medicaid beneficiaries across the US Qualitative: * Medicaid beneficiaries who identify as being at risk for poor outcomes 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
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Severe maternal morbidity (SMM) | 20 weeks gestation through 42 days postpartum | SMM rate based on the Centers for Disease Control algorithm |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All cause mortality | Delivery date through one year after delivery | Binary indicator of mortality based on Social Security Administration records |
| 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 |
| Medicaid managed care administrator perspectives on policy interventions | Year 3 | Qualitative self report of perspectives |
Countries
United States
Outcome results
None listed