Study protocol: a mixed-methods study of the implementation of doula care to address racial health equity in six state Medicaid programs.

Autor: Jarlenski M; Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, Pittsburgh, PA, 15261, United States of America. marian.jarlenski@pitt.edu.; Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America. marian.jarlenski@pitt.edu., Kennedy S; AcademyHealth, Washington, DC, United States of America., Johnson A; AcademyHealth, Washington, DC, United States of America., Hale C; AcademyHealth, Washington, DC, United States of America., D'Angelo Z; AcademyHealth, Washington, DC, United States of America., Nedhari A; Mamatoto Village, Washington, DC, United States of America., Coffee G; Genesis Birth Services, Williamsport, PA, United States of America.; PA Doula Commission, Landsdowne, PA, United States of America., Chappell-McPhail M; BirthMatters, Spartansburg, SC, United States of America., Green K; Black Mothers' Breastfeeding Association, Detroit, MI, United States of America., Méndez DD; Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America.; Center for Health Equity, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America., Goetschius LG; The Hilltop Institute, University of Maryland, Baltimore County, Baltimore, MD, United States of America., Gareau S; Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, SC, United States of America., Ashford K; College of Nursing, University of Kentucky, Lexington, United States of America., Barnes AJ; Health Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States of America., Ahrens KA; Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, ME, United States of America., Zivin K; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America., Mosley E; Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America., Tang L; Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America.
Jazyk: angličtina
Zdroj: Health research policy and systems [Health Res Policy Syst] 2024 Aug 08; Vol. 22 (1), pp. 98. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1186/s12961-024-01185-9
Abstrakt: 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.
Discussion: 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 ).
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje