Health equity research in obstetric anesthesia.
Health equity research in obstetric anesthesia.
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DOI：
10.1097/aco.0000000000001135
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发表时间：
2022-06-01
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健康公平是产科麻醉的一个重要优先事项，但描述围产期护理过程和健康结果的差异不足以实现这一目标。概念化和框架差异是提出有意义的研究问题的先决条件。我们强调需要假设和测试哪些机制和驱动因素对围产期过程和结果的差异起作用，以便确定、测试和完善有效的对策。我们重点关注方法和测量，概述了卫生系统和差异研究如何通过叙述、概念化和调查作为围产期差异关键驱动因素的健康社会决定因素，通过确定这种差异的细粒度机制，通过提出解决这些问题的经济案例，以及通过测试促进产科健康公平的具体干预措施，来促进孕产妇健康公平。在个人、家庭、社区/邻里层面精确测量健康的社会决定因素以及有意义的围产期过程和结果是医疗保健差异研究的先决条件。重点阐明导致产科护理过程中差异的精确机制将为促进健康公平提供更合理的努力。实施科学家应在前瞻性试验中严格调查哪些对策对于减轻围产期结局差异最有效。
Health equity is an important priority for obstetric anesthesia, but describing disparities in perinatal care process and health outcome is insufficient to achieve this goal. Conceptualizing and framing disparity is a prerequisite to pose meaningful research questions. We emphasize the need to hypothesize and test which mechanisms and drivers are instrumental for disparities in perinatal processes and outcomes, in order to target, test and refine effective countermeasures. With an emphasis on methodology and measurement, we sketch how health systems and disparity research may advance maternal health equity by narrating, conceptualizing, and investigating social determinants of health as key drivers of perinatal disparity, by identifying the granular mechanism of this disparity, by making the economic case to address them, and by testing specific interventions to advance obstetric health equity. Measuring social determinants of health and meaningful perinatal processes and outcomes precisely and accurately at the individual, family, community/neighborhood level is a prerequisite for healthcare disparity research. A focus on elucidating the precise mechanism driving disparity in processes of obstetric care would inform a more rational effort to promote health equity. Implementation scientists should rigorously investigate in prospective trials which countermeasures are most efficient and effective in mitigating perinatal outcome disparities.