Multi-Level Analysis of Perinatal Toxicology Practices in New York State: An Explanatory-Sequential Mixed-Methods Study - Maternal mortality rates from drug overdoses have increased, especially among pregnant and postpartum women aged 35 to 44. Despite the essential need for effective screening, education, and referrals, there is limited understanding of how well substance use screening works during pregnancy. Additionally, pregnant women frequently encounter barriers to accessing prenatal care due to variations in perinatal drug toxicology testing practices across patient population. This K01 application focuses on examining variation in perinatal drug toxicology screening policies and practices using the Socio-cultural Framework for the Study of Health Service Disparities “SCF-HSD (Alegría, 2010). The study will progress through three phases: (1) use multilevel statistical models with NYS Medicaid claims data to identify predictors of perinatal toxicology testing and characterize hospital variations across over 600,000 mother-infant dyads in 225 hospitals from 2021 to 2024; (2) conduct 1:1 interviews with hospital administrators and staff to collect and analyze toxicology testing policies and practices, capturing multiple perspectives on testing attitudes and adherence; (3) integrate quantitative and qualitative findings from Aims 1 and 2 using a mixed methods design, incorporating patient perspectives via focus group sessions to develop hospital policy recommendations. Dr. Choi's career development plan involves receiving interdisciplinary mentorship to advance her skills in data-driven mixed methods research. In the era of big data, there is a growing need for mixed methods research training that equips individuals with the skills to harness big datasets and employ qualitative approaches informed by stakeholders (e.g., OB/GYN, social workers, hospital administrators, and patients) to understand complex computations. This includes training in 1) evaluating policy and system-level contributors to perinatal health research; 2) advanced multi-level modeling techniques; 3) qualitative research; and 4) mixed methods research. The plan aims to build Dr. Choi's expertise in perinatal health, with a focus on examining patient-centered approaches for exploring perinatal health care quality and access. Her career goals include enhancing the understanding of substance use screening effectiveness, improving healthcare practices, and developing targeted interventions to improve perinatal and infant health. The career development award will support Dr. Choi in a collaborative and resource-rich academic environment at New York University Grossman School of Medicine. She will actively participate in professional development activities to disseminate research findings and foster collaborations. She will have access to Medicaid data, experienced mentors, and advisors, which will support impactful research and the implementation of findings to improve health outcomes for all populations, with a particular focus on perinatal substance use.
