Center for Clinical and Translational Science

临床和转化科学中心

• 批准号: 10200215
• 负责人: Robert P. Kimberly
• 金额: $ 14.85万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-06 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200215
• 关键词: Address; Administrator; Age; Alabama; Area; Cessation of life; Clinic; Clinical Research; Clinical Sciences; Communities; Country; County; Data; Discipline of obstetrics; Discrimination; Education; Ethnic group; Family; Future; Goals; Health Personnel; Health system; Healthcare Systems; Incidence; Income; Individual; Informatics; Intervention; Interview; Life; Live Birth; Longitudinal Studies; Maternal Health; Maternal Mortality; Maternal and Child Health; Maternal-fetal medicine; Medical History; Medicine; Methods; Modality; Morbidity - disease rate; Mothers; Neighborhoods; Not Hispanic or Latino; Outcome; Participant; Patients; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Outcome; Pregnant Women; Prevention strategy; Program Reviews; Provider; Race; Reporting; Research; Resources; Retrospective cohort study; Role; Services; Societies; Surveys; System; Tern; Time; Translational Research; Trust; United States; United States National Institutes of Health; Vision; Woman; base; clinical care; clinical center; college; community organizations; design; ethnic diversity; evidence base; experience; geographic difference; health disparity; high risk; implicit bias; improved; informant; interest; low socioeconomic status; maternal outcome; multidisciplinary; multilevel analysis; obstetric care; pregnant; prevent; prospective; racial and ethnic; racial difference; racial disparity; racism; referral services; research study; residence; severe maternal morbidity; social culture; sociodemographics; tool; trend

PROJECT SUMMARY Maternal mortality (MM) and severe maternal morbidity (SMM) are higher in the United States (US) than any other high-income country and have increased over time. This national maternal health crisis is also characterized by significant racial disparity. MM is three times as likely among non-Hispanic black women as non-Hispanic white women. Likewise, non-Hispanic black women are twice as likely to experience SMM even when controlling for sociodemographic confounders. Given that over 60% of US maternal deaths could be prevented, there is an urgent need for research to better understand and address the pervasive and persistent health disparities. Consistent with the goals of this Notice of Special Interest (NOT-OD-20-104), we will utilize established community-engaged approaches to better understand racial disparities in pregnancy-related and pregnancy-associated MM and SMM in the priority region of the US South. Our multidisciplinary team will leverage the clinical research informatics and community engagement resources of the Center for Clinical and Translational Science (CCTS) to identify multi-level (individual, interpersonal, community, and sociocultural) determinants of maternal health disparities, as well as factors that contribute to optimal maternal outcomes in high risk Southern communities. This research will focus on women in Alabama, the state with the third highest MM in the country. The first specific aim is retrospective cohort study of over 40,000 obstetric patients over the past 10 years to better evaluate the individual (race, age, education, payer status, medical history), community (residence), and system (clinic/provider) factors associated with MM and SMM. The second specific aim is to identify provider, system and community-based perspectives on potential areas of intervention to improve maternal outcomes and reduce racial inequities in MM and SMM. The third specific aim is a prospective mixed- methods study of obstetric patients to examine healthcare system distrust, perceived discrimination and racism experienced by black women receiving obstetric care (hypothesized contributing factors to the 3 to 4 times higher rate of MM experienced by black mothers). We believe that accomplishing the aims below will significantly contribute to the evidence-base for NIH’s forthcoming Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative and future longitudinal studies by this research team.

项目摘要 美国的孕产妇死亡率（MM）和严重孕产妇发病率（SMM）高于任何 其他高收入国家，并随着时间的推移而增加。这场全国性的孕产妇健康危机也是 以明显的种族差异为特点。MM在非西班牙裔黑人女性中的可能性是 非西班牙裔白色女性。同样，非西班牙裔黑人女性经历SMM的可能性是黑人女性的两倍， 当控制社会人口学混杂因素时。鉴于超过60%的美国孕产妇死亡可能是 因此，迫切需要进行研究，以更好地了解和解决普遍和持续的 健康差距。根据本特别关注通知（NOT-OD-20-104）的目标，我们将利用 建立社区参与的方法，以更好地了解与怀孕有关的种族差异， 妊娠相关MM和SMM在美国南部的优先区域。我们的多学科团队将 利用临床研究信息学和临床中心的社区参与资源， 翻译科学（CCTS），以确定多层次（个人，人际，社区和社会文化） 产妇保健差异的决定因素，以及有助于产妇保健取得最佳成果的因素， 南方高危社区。这项研究将集中在亚拉巴马的妇女，该州的第三高 MM在国内第一个具体目标是对40，000多名产科患者进行回顾性队列研究， 过去10年，以更好地评估个人（种族、年龄、教育、付款人身份、病史）、社区 （居住地）和系统（诊所/提供者）因素与MM和SMM相关。第二个具体目标是 确定提供者、系统和社区对潜在干预领域看法，以改进 产妇的结果和减少MM和SMM的种族不平等。第三个具体目标是一个预期的混合- 方法对产科病人的研究，以检查医疗保健系统的不信任，感知的歧视和种族主义 接受产科护理的黑人妇女所经历的（假设的促成因素比接受产科护理的黑人妇女高3至4倍） 黑人母亲经历的MM率）。我们认为，实现以下目标将大大 为NIH即将推出的实施孕产妇健康和产前检查的证据基础做出贡献 结果每个人的愿景（改进）倡议和该研究小组未来的纵向研究。