Study protocol

A mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN

Erika Cottrell, Blair Darney, Miguel Marino, Anna Rose Templeton, Lorie Jacob, Megan Hoopes, Maria Rodriguez, Brigit Hatch

Research output: Contribution to journalArticle

Abstract

Background: Evidence-based reproductive care reduces morbidity and mortality for women and their children, decreases health disparities and saves money. Community health centres (CHCs) are a key point of access to reproductive and primary care services for women who are publicly insured, uninsured or unable to pay for care. Women of reproductive age (15-44 years) comprise just of a quarter (26%) of the total CHC patient population, with higher than average proportions of women of colour, women with lower income and educational status and social challenges (e.g. housing). Such factors are associated with poorer reproductive health outcomes across contraceptive, preventive and pregnancy-related services. The Affordable Care Act (ACA) prioritised reproductive health as an essential component of women's preventive services to counter these barriers and increase women's access to care. In 2012, the United States Supreme Court ruled ACA implementation through Medicaid expansion as optional, creating a natural experiment to measure the ACA's impact on women's reproductive care delivery and health outcomes. Methods: This paper describes a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. Quantitative assessment will leverage electronic health record data from the ADVANCE Clinical Research Network, a network of over 130 CHCs in 24 states, to describe care and identify patient, practice and state-level factors associated with provision of recommended evidence-based care. Qualitative assessment will include patient, provider and practice level interviews to understand perceptions and utilisation of reproductive healthcare in CHC settings. Discussion: To our knowledge, this will be the first study using patient level electronic health record data from multiple states to assess the impact of ACA implementation in conjunction with other practice and policy level factors such as Title X funding or 1115 Medicaid waivers. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes and reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualise our findings and develop subsequent studies and interventions to support women's healthcare provision in CHC settings.

Original languageEnglish (US)
Article number58
JournalHealth Research Policy and Systems
Volume17
Issue number1
DOIs
StatePublished - Jun 11 2019

Fingerprint

Patient Protection and Affordable Care Act
Delivery of Health Care
Safety
Community Health Centers
Medicaid
Electronic Health Records
Reproductive Health
Contraceptive Agents
Supreme Court Decisions
Interviews
Postnatal Care
Educational Status
Preventive Medicine
Prenatal Care
Health Status
Primary Health Care
Patient Care

Keywords

  • Affordable Care Act
  • community health centres
  • contraceptive care
  • electronic health records
  • postpartum care
  • prenatal care
  • reproductive health
  • Women's health
  • women's preventive care

ASJC Scopus subject areas

  • Health Policy

Cite this

Study protocol : A mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN. / Cottrell, Erika; Darney, Blair; Marino, Miguel; Templeton, Anna Rose; Jacob, Lorie; Hoopes, Megan; Rodriguez, Maria; Hatch, Brigit.

In: Health Research Policy and Systems, Vol. 17, No. 1, 58, 11.06.2019.

Research output: Contribution to journalArticle

@article{04d2d124d10c4212a1f759ce02e2f61c,
title = "Study protocol: A mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN",
abstract = "Background: Evidence-based reproductive care reduces morbidity and mortality for women and their children, decreases health disparities and saves money. Community health centres (CHCs) are a key point of access to reproductive and primary care services for women who are publicly insured, uninsured or unable to pay for care. Women of reproductive age (15-44 years) comprise just of a quarter (26{\%}) of the total CHC patient population, with higher than average proportions of women of colour, women with lower income and educational status and social challenges (e.g. housing). Such factors are associated with poorer reproductive health outcomes across contraceptive, preventive and pregnancy-related services. The Affordable Care Act (ACA) prioritised reproductive health as an essential component of women's preventive services to counter these barriers and increase women's access to care. In 2012, the United States Supreme Court ruled ACA implementation through Medicaid expansion as optional, creating a natural experiment to measure the ACA's impact on women's reproductive care delivery and health outcomes. Methods: This paper describes a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. Quantitative assessment will leverage electronic health record data from the ADVANCE Clinical Research Network, a network of over 130 CHCs in 24 states, to describe care and identify patient, practice and state-level factors associated with provision of recommended evidence-based care. Qualitative assessment will include patient, provider and practice level interviews to understand perceptions and utilisation of reproductive healthcare in CHC settings. Discussion: To our knowledge, this will be the first study using patient level electronic health record data from multiple states to assess the impact of ACA implementation in conjunction with other practice and policy level factors such as Title X funding or 1115 Medicaid waivers. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes and reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualise our findings and develop subsequent studies and interventions to support women's healthcare provision in CHC settings.",
keywords = "Affordable Care Act, community health centres, contraceptive care, electronic health records, postpartum care, prenatal care, reproductive health, Women's health, women's preventive care",
author = "Erika Cottrell and Blair Darney and Miguel Marino and Templeton, {Anna Rose} and Lorie Jacob and Megan Hoopes and Maria Rodriguez and Brigit Hatch",
year = "2019",
month = "6",
day = "11",
doi = "10.1186/s12961-019-0445-y",
language = "English (US)",
volume = "17",
journal = "Health Research Policy and Systems",
issn = "1478-4505",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Study protocol

T2 - A mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN

AU - Cottrell, Erika

AU - Darney, Blair

AU - Marino, Miguel

AU - Templeton, Anna Rose

AU - Jacob, Lorie

AU - Hoopes, Megan

AU - Rodriguez, Maria

AU - Hatch, Brigit

PY - 2019/6/11

Y1 - 2019/6/11

N2 - Background: Evidence-based reproductive care reduces morbidity and mortality for women and their children, decreases health disparities and saves money. Community health centres (CHCs) are a key point of access to reproductive and primary care services for women who are publicly insured, uninsured or unable to pay for care. Women of reproductive age (15-44 years) comprise just of a quarter (26%) of the total CHC patient population, with higher than average proportions of women of colour, women with lower income and educational status and social challenges (e.g. housing). Such factors are associated with poorer reproductive health outcomes across contraceptive, preventive and pregnancy-related services. The Affordable Care Act (ACA) prioritised reproductive health as an essential component of women's preventive services to counter these barriers and increase women's access to care. In 2012, the United States Supreme Court ruled ACA implementation through Medicaid expansion as optional, creating a natural experiment to measure the ACA's impact on women's reproductive care delivery and health outcomes. Methods: This paper describes a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. Quantitative assessment will leverage electronic health record data from the ADVANCE Clinical Research Network, a network of over 130 CHCs in 24 states, to describe care and identify patient, practice and state-level factors associated with provision of recommended evidence-based care. Qualitative assessment will include patient, provider and practice level interviews to understand perceptions and utilisation of reproductive healthcare in CHC settings. Discussion: To our knowledge, this will be the first study using patient level electronic health record data from multiple states to assess the impact of ACA implementation in conjunction with other practice and policy level factors such as Title X funding or 1115 Medicaid waivers. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes and reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualise our findings and develop subsequent studies and interventions to support women's healthcare provision in CHC settings.

AB - Background: Evidence-based reproductive care reduces morbidity and mortality for women and their children, decreases health disparities and saves money. Community health centres (CHCs) are a key point of access to reproductive and primary care services for women who are publicly insured, uninsured or unable to pay for care. Women of reproductive age (15-44 years) comprise just of a quarter (26%) of the total CHC patient population, with higher than average proportions of women of colour, women with lower income and educational status and social challenges (e.g. housing). Such factors are associated with poorer reproductive health outcomes across contraceptive, preventive and pregnancy-related services. The Affordable Care Act (ACA) prioritised reproductive health as an essential component of women's preventive services to counter these barriers and increase women's access to care. In 2012, the United States Supreme Court ruled ACA implementation through Medicaid expansion as optional, creating a natural experiment to measure the ACA's impact on women's reproductive care delivery and health outcomes. Methods: This paper describes a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. Quantitative assessment will leverage electronic health record data from the ADVANCE Clinical Research Network, a network of over 130 CHCs in 24 states, to describe care and identify patient, practice and state-level factors associated with provision of recommended evidence-based care. Qualitative assessment will include patient, provider and practice level interviews to understand perceptions and utilisation of reproductive healthcare in CHC settings. Discussion: To our knowledge, this will be the first study using patient level electronic health record data from multiple states to assess the impact of ACA implementation in conjunction with other practice and policy level factors such as Title X funding or 1115 Medicaid waivers. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes and reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualise our findings and develop subsequent studies and interventions to support women's healthcare provision in CHC settings.

KW - Affordable Care Act

KW - community health centres

KW - contraceptive care

KW - electronic health records

KW - postpartum care

KW - prenatal care

KW - reproductive health

KW - Women's health

KW - women's preventive care

UR - http://www.scopus.com/inward/record.url?scp=85067244637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067244637&partnerID=8YFLogxK

U2 - 10.1186/s12961-019-0445-y

DO - 10.1186/s12961-019-0445-y

M3 - Article

VL - 17

JO - Health Research Policy and Systems

JF - Health Research Policy and Systems

SN - 1478-4505

IS - 1

M1 - 58

ER -