Effects of health policy on the health of people with systemic autoimmune and rheumatic diseases

ABSTRACT Systemic autoimmune and rheumatic diseases (SARDs) most often occur in females (80% of people with autoimmunity are female). Past research has shown that women with SARDs have a significantly increased risk of adverse pregnancy outcomes compared to the population average. However, little research has investigated how health policies affect the delivery of healthcare to people with SARDs, and how this might affect their health during reproductive years and during the pregnancy and postpartum period. Pregnant individuals with SARDs will be directly affected by health policies that affect their access to high quality care. Health policies are also likely to affect non-pregnant females, particularly around healthcare quality, access to effective treatments, and health outcomes. The medical decision-making of rheumatologists—specialists in the healthcare of people with SARDs -- may also be affected by health policies. Using multi-method approaches, this study will provide an assessment of how health policies are affecting the health outcomes and healthcare of reproductive-age females with SARDs. Stratifying by state policy context, we will qualitatively interview patients with SARDs who are currently pregnant to understand their experiences with fertility and access to pregnancy care. We will interview rheumatologists to assess how policy influences medical decision-making, prescribing practices, and referrals for pregnancy and perinatal care. Using national claims data, we will evaluate pregnancy outcomes among women with SARDs (e.g., severe maternal morbidity), and healthcarerelated outcomes among non-pregnant women with SARDs (e.g., prescription medication use). Findings from the study will inform a policy and public health response that enhances patient-centered healthcare for women with SARDs