CTSA Admin Supp2 Maternal Mortality - UL1 - Revision

产科服务的缺乏影响了美国2700多万名妇女和婴儿，代表着 对主要是农村州来说，这是巨大的资源和财政负担。妊娠高血压综合征(HTN) 包括先兆子痫(PEC)是一个主要的健康问题，并与显著增加的 严重孕产妇发病率(SMM)和死亡率(MM)。管理慢性疾病，如HTN， 特别是在居住在农村地区的怀孕人口中，可以对最佳 产妇/新生儿结局。然而，使用先进的电信技术来支持和 促进远程临床医疗，包括远程医疗和远程患者监控(RPM)可以提供 农村地区有专门的医疗保健服务，可以提高护理质量，减少昂贵的再住院费用 和紧急护理就诊，以及较低的医疗差距。阿肯色大学医学分校 (UAMS)是该州唯一的学术健康科学中心，是HIGH- 来自阿肯色州农村的怀孕风险。这些妇女中的许多人为产前检查而单程旅行长达4小时。不 只有与医疗团队的这种距离才会给患者带来经济负担，这也是一种 为需要干预的孕妇提供及时干预的障碍。UAMS拥有近15年的 在以农村为主的阿肯色州(AR)体验开创性的远程医疗(TM)。此建议的应用程序 旨在开发和测试一种方案，以测试用于监测孕妇血压(BP)的RPM集成 将血压升高的妇女纳入农村TM诊所高危妊娠的护理标准，这是得到支持的 通过全天候呼叫中心(CC)。这项建议符合行政副刊的目标，以扩大 研究重点是美国的孕产妇死亡率和妊娠相关发病率，以加强 循证护理和预防战略，改善低资源环境和高资源环境下的结果 负担美国境内的人口(例如，种族/民族和/或农村人口)。此外，这项建议与 CTSA U01拨款的使命，包括扩大临床和翻译研究机会 寿命和在代表性不足的人群中，以及扩大临床和转化的影响 在农村人口中和与农村人口一起进行研究。总体目标是改善对患有HTN的孕妇的护理 在农村、低卫生资源地区，将RPM整合到现有的TM服务中。因此，我们建议 证明多层次干预的集成TM+CC+RPM系统将改善患者的 合规和病人护理，同时解决产妇发病率和死亡率方面的差异。这项研究的目的 包括：目标1：制定一项自我监测的RPM协议，纳入现有的IDHI农村远程医疗 (TM)临床和呼叫中心(CC)模式，用于监测妊娠期HTN。(TM+CC+RPM)目标2：实施 建立集成模型并评估参与者对RPM设备和集成系统的满意度 使用混合方法。

The lack of obstetric services impacts more than 27 million women and infants in the US and represents significant resource and financial burdens for primarily rural states. Hypertension (HTN) in pregnancy including preeclampsia (PEC) is a major health problem and is associated with significant increased severe maternal morbidity (SMM) and mortality (MM). Management of a chronic condition such as HTN, especially in a pregnant population residing in rural areas, can have a significant impact on optimal maternal/neonatal outcomes. However, the use of advanced telecommunication technologies to support and promote long-distance clinical health care, including telehealth and remote patient monitoring (RPM) can provide rural areas with specialty health care services that can increase the quality of care, reduce costly readmissions and emergent care visits, and lower healthcare disparities. The University of Arkansas for Medical Sciences (UAMS), the only academic health science center in the state, serves as one of the only referral sources for high- risk pregnancies from rural Arkansas. Many of these women travel up to 4 hours one-way for prenatal visits. Not only does this distance from the healthcare team place a burden on the patient financially, it also poses as a barrier to receive timely interventions to pregnant women who require them. UAMS has nearly 15 years of experience pioneering telemedicine (TM) in a primarily rural state, Arkansas (AR). This proposed application aims to develop and test a protocol to test an integration of RPM for monitoring blood pressure (BP) in pregnant women with elevated BP into the standard of care in rural TM clinic for high-risk pregnancies which is supported by a 24/7 Call Center(CC). This proposal in line with goals of the Administrative Supplement to Expand Research Focused on Maternal Mortality and pregnancy-associated morbidity in the U.S. to strengthen evidence-based care and prevention strategies and improve outcomes in low-resource settings and high burden populations (e.g., racial/ethnic and/or rural) within the U.S. Additionally, this proposal aligns with the mission of CTSA U01 grant which includes expanding clinical and translational research opportunities across the lifespan and in underrepresented populations along with expanding the impact of clinical and translational research in and with rural populations. Overall goals is to improve care for pregnant women with HTN who live in rural, low-health resource areas by integrating RPM into current TM services. Therefore, we propose to demonstrate that an integrated TM+CC+RPM system with multi-level intervention will improve patients' compliance and patient care while addressing disparities in maternal morbidity and mortality. The study's aims include: Aim 1: Develop a self-monitoring RPM protocol that integrates into the existing IDHI rural telemedicine (TM) clinic and call center (CC) model for monitoring HTN in pregnancy. (TM + CC+ RPM) Aim 2: Implement the integrated model and assess participants' satisfaction toward the RPM device and the integrated system using a mixed-method approach.