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Reducing Maternal Health Disparities: Effects of Recent Health Workforce Policies

Award Number: R01NR020859
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/22/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2026

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Reducing Maternal Health Disparities: Effects of Recent Health Workforce Policies - PROJECT SUMMARY/ABSTRACT The U.S. is facing a serious crisis of rising rates of maternal mortality and severe morbidity, which are attributable to multiple factors, such as the persistent, deep shortages of maternal care workforce in disadvantaged urban communities and rural areas. Since half of U.S. counties do not have a single obstetrician-gynecologist (OB-GYN), access to maternal care is a daunting challenge facing the nearly seven million reproductive-age women living in those counties. To address the problem of unequal distribution of clinicians, policymakers have taken considerable efforts in recent decades. Among the efforts, the National Health Service Corps (NHSC) remains the single largest policy intervention that has been launched to recruit clinicians to health professional shortage areas (HPSAs). The NHSC has experienced a dramatic expansion during the past decade, first through the American Recovery and Reinvestment Act in 2009 and then by the Affordable Care Act in 2010. Prior studies have found that these two Acts have raised the NHSC’s annual budget by over 100% and led to a significant expansion of the NHSC’s clinician workforce, such as OB-GYNs and certified nurse-midwives. However, no study to date has evaluated the impact of the NHSC expansion on disparities in maternal care and outcomes between the HPSAs and other areas. This proposed project aims to examine these issues and fill the gap in the literature. To our knowledge, it will be the first study to examine the effect of the recent NHSC expansion on disparities in maternal care and outcomes. Specifically, the project aims to assess how the recent NHSC expansion affects disparities in (1) maternal mortality overall and in-hospital mortality in particular, (2) severe maternal morbidity during childbirth hospitalizations and the associated hospital delivery costs and length of stay, (3) labor and delivery care, and (4) timing and adequacy of prenatal care and birth outcomes. To examine these aims, we will use multiple large, national data files over an extended period of 15 years between 2005 and 2019. To analyze the data, we will take two complementary approaches, including a difference-in-differences method, and an instrumental variable approach. Our analyses are expected to provide rigorous quasi-experimental evidence about the effects of workforce policy changes on disparities in maternal mortality and severe morbidity, which are key objectives of the Healthy People 2030. Our study findings will have important implications for the upcoming implementation of the 2018 Improving Access to Maternity Care Act, the latest NHSC policy change intended to better serve reproductive-age women in HPSAs by further increasing the NHSC supported maternal care providers.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $596,801 )
2025	2025	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Nursing Research	000	4	6/30/2025	NON-COMPETING CONTINUATION	$596,801
														Subtotal = $596,801

Issue Date FY: 2024 ( Subtotal = $596,801 )
2024	2024	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Nursing Research	000	3	6/10/2024	NON-COMPETING CONTINUATION	$596,801
														Subtotal = $596,801

Issue Date FY: 2023 ( Subtotal = $793,967 )
2023	2023	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Nursing Research	001	2	7/28/2023	NON-COMPETING CONTINUATION	$793,967
2023	2022	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Nursing Research	000	1	7/24/2023	NEW	$0
														Subtotal = $793,967

Issue Date FY: 2022 ( Subtotal = $817,295 )
2022	2022	HARVARD PILGRIM HEALTH CARE INC	93 WORCESTER ST	WELLESLEY	MA	02481	NORFOLK	USA	Nursing Research	000	1	9/23/2022	NEW	$817,295
														Subtotal = $817,295

Grand Total All Awards = $2,804,864

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Reducing Maternal Health Disparities: Effects of Recent Health Workforce Policies

Award Number: R01NR020859

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/22/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2026

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