Integrated Supportive Care Programs to Improve Maternal Health

In New York City (NYC) and State (NYS), lack of access to high-quality, patient-centered perinatal health care drives high rates of maternal mortality (MM) and severe maternal mortality (SMM). Interventions that emphasize access to quality, obstetric services – i.e., integrated supportive care (ISC) – hold significant promise. NYC and NYS are at the forefront of implementing ISC doula programs, with recent expansion of the Maternity Hospital Quality Improvement Network (MHQIN), which supports hospitals in integrating doulas and Standards for Respectful Care at Birth, and the Citywide Doula Initiative (CDI), which trains and provides doulas at no cost for NYC residents in select neighborhoods who are eligible for Medicaid. However, there is little empirical evidence on the effectiveness of doula care models or the facilitators and barriers doulas face in practicing within their full scope, integrating into the care team, and strategies for effective, sustainable ISC implementation. We propose a rigorous mixed-methods evaluation of the multi- level impacts and implementation of NYC’s doula programs. In Aim 1, we will use a quasi-experimental design and unique Medicaid claims data linked to social services data to evaluate the overall and differential effects (by age, chronic disease status, and geography) of the CDI on 1a) health outcomes (infant birth outcomes and maternal mental health, cardiovascular health, and SMM outcomes); 1b) prenatal and postpartum health care utilization; and 1c) receipt of social services, among Medicaid- eligible women from 2022 to 2027. In Aim 2, we will evaluate stakeholders’ perspectives on and experiences with evaluate the MHQIN program components and implementation via in-depth individual interviews, focus group discussions, and surveys with patients, doulas, health care professionals, and other hospital and government stakeholders. In Aim 3, we will develop an evidence-based strategic plan to scale and sustain Medicaid-supported ISC, including doula reimbursement. We will generate new evidence on the role that doulas play in improving maternal health, strengthen local partnerships, and serve as a model for national replicability. Our proposal is highly aligned with NIH’s strategic plan for innovative research to advance multi-level solutions to improve women’s health across the U.S.