Juanita Jeanne Chinn
$707,192
Meredith Matone
University of Pennsylvania
Pennsylvania
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
The maternal mortality rate in the United States (US) is the highest among high-income countries and has been steadily rising in recent years. Near misses for maternal mortality, including both physical health indicators captured by severe maternal morbidity (SMM) and mental health near misses such as suicidality and overdose (hereafter, SMM+), are also increasing among birthing individuals. Racial and other disparities in maternal mortality and SMM+ are widening. Telehealth utilization increased dramatically in response to the COVID-19 pandemic and has great potential to reduce SMM+ and SMM+ disparities through increasing healthcare access and utilization, patient experience, and quality of care. However, there is little data on maternal safety outcomes like SMM+, whether telehealth could reduce or exacerbate disparities in SMM+, and how telehealth can be optimized with the goal of reducing SMM+ and SMM+ disparities. This project will determine the impact of telehealth on SMM+ and SMM+ disparities and develop multidisciplinary clinical and community consensus guidelines for how telehealth can be implemented to address equity issues and reduce disparities in SMM+. We will apply a mixed-methods approach, conducting novel causal inference analyses of a national Medicaid claims database, the largest US health insurance provider during pregnancy (>40% of births; 65% of births to Black individuals), and qualitative work centered in Philadelphia, a city with a high maternal mortality rate and one of the country's only local maternal mortality review committees. We will form a community advisory board (CAB) that includes multidisciplinary stakeholders and lived experience experts to provide substantial input on all aspects of the proposal. Specifically, we will estimate effects of hybrid telehealth versus in-person only prenatal and postpartum care strategies and state policies expanding coverage for telehealth modalities on SMM+ and SMM+ disparities using a novel trial emulation framework (Aim 1); identify barriers and facilitators to implementing telehealth care with the goal of reducing SMM+ and SMM+ disparities (Aim 2); and develop and disseminate best practice recommendations for using telehealth to detect early warning signs of SMM+ (Aim 3). Successful completion of this work will fill critical gaps in knowledge about the safety, effectiveness and equitableness of maternity telehealth care and how telehealth can be leveraged to reduce maternal health disparities. Through sustained partnership with a CAB and dissemination of best practice recommendations, our methodologically innovative project will inform care, guidelines, and policy in Philadelphia and nationally. By sharing our project's key findings, methods and software code, we will generate a community-driven research agenda and cultivate collaborators for future research using our database and CAB.