The “Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal” Project: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Priya Batra MD, MS, FACOG , Gabriela Alvarado MD, MSc, MA, MPhil , Chloe E. Bird PhD, FAAAS, FAAHB
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引用次数: 0

Abstract

Background

Through applied research and health care quality improvement, California has achieved a maternal mortality (MM) rate significantly lower than that measured nationally. However, Medicaid (Medi-Cal)-insured births in the state continue to experience disproportionate shares of MM and severe maternal morbidity (SMM), which often precedes death. Failure to engage the Medi-Cal community in this work may impede efforts to increase equity.

Methods

This community engagement project used deliberative democracy methods to engage stakeholders with lived experience in California's Medi-Cal perinatal care system to generate an actionable and specific agenda of recommendations to decrease MM and SMM in the Medi-Cal population.

Findings

A total of 37 Medi-Cal stakeholders—representing birthing people, providers, health plan administrators, and advocates—participated in longitudinal co-learning sessions on the topics of MM/SMM in Medi-Cal. Most of these stakeholders (75.7%) then participated in deliberation sessions. Deliberation recommendations fell into five distinct categories: Medi-Cal perinatal covered benefits, data collection and dissemination, patient experience and its link to care quality, Medi-Cal reimbursement rates, and accountability with respect to racism in perinatal care. Stakeholders identified the Medi-Cal system actors best positioned to implement specific recommendations to directly impact MM/SMM.

Conclusions

This project demonstrates the feasibility and success of using deliberative democracy methods to generate local and community-generated solutions to critical problems in health equity. Active and engaged stakeholders were keen to identify both immediate actions and long-term research and quality improvement paradigm shifts to support birth equity in Medi-Cal.

Medi-Cal“以出生为中心的结果研究参与(B-CORE)”项目:降低孕产妇死亡率和严重孕产妇发病率的社区建议
背景通过应用研究和医疗保健质量的提高,加利福尼亚州的孕产妇死亡率显著低于全国水平。然而,该州的医疗补助(Medi-Cal)保险分娩继续经历不成比例的MM和严重孕产妇发病率(SMM),这通常发生在死亡之前。未能让Medi-Cal社区参与这项工作可能会阻碍提高公平性的努力。方法该社区参与项目使用协商民主方法,让在加州Medi-Cal围产期护理系统有生活经验的利益相关者参与进来,以制定一个可操作的具体建议议程,减少Medi-Cal人群中的MM和SMM。发现共有37名Medi-Cal利益相关者——代表出生者、提供者、健康计划管理员和倡导者——参加了Medi-Cal关于MM/SMM主题的纵向共同学习会议。这些利益相关者中的大多数(75.7%)随后参加了审议会议。审议建议分为五类:Medi-Cal围产期保险福利、数据收集和传播、患者体验及其与护理质量的联系、Medi-Cal报销率以及对围产期护理中种族主义的问责。利益相关者确定了Medi-Cal系统最适合实施具体建议以直接影响MM/SMM的参与者。结论该项目证明了使用协商民主方法为卫生公平的关键问题制定地方和社区解决方案的可行性和成功性。积极参与的利益相关者热衷于确定立即行动和长期研究以及质量改进范式的转变,以支持Medi-Cal的出生公平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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