DOI: 10.3886/e182923v1
title: Companion Files for Racial Differences in Patient Experience and Diabetes Management Outcomes among Reproductive-Age Women

description: Significant racial and ethnic disparities in cardiometabolic diseases, such as diabetes, underline entrenched health inequalities in the United States. Non-pregnant, non-Hispanic black women of reproductive age (18-45 years) are more likely to have diagnosed and undiagnosed diabetes, which increases their risk of maternal morbidity and mortality during the perinatal period. Adherence to disease management and monitoring during the preconception period is crucial, especially among non-Hispanic black women who are disproportionately impacted by maternal morbidity and mortality. Studies have shown positive patient experiences are associated with adherence to recommended medication and treatment, preventive care use, and self-rated health outcomes. There is a dearth of studies, however, examining the effects of patient experiences (and racial differences in patient experiences) on chronic disease management outcomes specifically among non-pregnant, reproductive-age women with diabetes. An understanding of these associations have important implications for maternal morbidity and mortality. The goal of this study is to use the Medical Expenditure Panel Survey datasets (2012-2017 longitudinal files) and robust statistical modeling techniques to investigate racial differences in patient experience among non-pregnant, reproductive-age women with diabetes and its relation to ratings of health care received, diabetes care self-efficacy, and diabetes care monitoring. This study provides important information for researchers, clinicians, and policy-makers. The research addresses the Maternal and Child Health Bureau (MCHB) Strategic Research Issue II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations. This study informs the development of equitable clinical patient-centered practices that promote optimal disease management among diverse women and reduce racial and ethnic disparities in maternal health outcomes. It also strengthens and expands MCH Services Block Grant National Performance and Population Priority Domain I: “Well-Woman Visits and Preconception/Interconception Health”. This study is expected to help determine whether positive patient experiences can improve women’s confidence in their abilities to manage their diabetes, and increase their likelihood of receiving recommended diabetes care during the preconception or interconception period. By elucidating the mechanisms by which promoting patient-centered diabetes care interventions during the preconception/interconception period might improve disease management, our study can inform practices and policies that contribute to the attainment of following Healthy People 2020 Maternal, Infant, and Child Health (MIC) Objectives: Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors (MICH-16); Reduce the rate of maternal illness and complications due to pregnancy (MICH-6); and Reduce the rate of maternal mortality (MICH-5). Furthermore, our study findings are expected identify the patient experiences that have the greatest impact on diabetes management outcomes, and can lead to policy changes for provider reimbursements for demonstrating quality patient-provider interactions. By providing insights into ways health care professionals can better communicate with this at-risk population, our study is relevant to the attainment of Healthy People 2020 Health Communication and Health Information Technology (HC/HIT) Objectives: Increase the proportion of persons who report that their health care providers have satisfactory communication skills (HC/HIT-2) and Increase the proportion of persons who report that their health care providers always involved them in decisions about their health care as much as they wanted (HC/HIT-3).