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 G.
AU - Marino, Miguel
AU - Templeton, Anna Rose
AU - Jacob, Lorie
AU - Hoopes, Megan
AU - Rodriguez, Maria
AU - Hatch, Brigit
N1 - Publisher Copyright:
© 2019 The Author(s).
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 - Women's health
KW - community health centres
KW - contraceptive care
KW - electronic health records
KW - postpartum care
KW - prenatal care
KW - reproductive 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
C2 - 31186028
AN - SCOPUS:85067244637
SN - 1478-4505
VL - 17
JO - Health Research Policy and Systems
JF - Health Research Policy and Systems
IS - 1
M1 - 58
ER -