UCLA Clinical Translational Science Institute

项目摘要 美国妇产科医师学会建议对产妇进行适当的护理 (ACOG)、母胎医学学会(SMFM)、疾病控制中心(CDC)和其他 利益攸关方作为一项国家全系统建议，以提高分娩安全并减少 孕产妇发病率和死亡率上升。奥组委、SMFM和其他各种利益相关者倡导 用于根据医院资源认证医院，该系统从I级到IV级，其中I级具有 资源，并为低风险妇女提供护理，二级和三级照顾中等风险妇女，以及 IV级是一个区域中心，可以全天候获得现场多学科顾问和重症护理资源。 为响应美国国立卫生研究院的改善倡议，本补充提案侧重于出血--第四个领导 产妇死亡的原因。报告表明，66-93%以上的比例可能是可以避免的，使其成为领先的 可预防的孕产妇死亡原因。胎盘异常(植入胎盘谱系(PAS)障碍和 前置胎盘)是出血的主要原因。由于剖腹产率的增加，剖腹产率也在增加 剖腹产的风险因种族/民族而异。许多研究人员、临床医生和患者倡导者 团体支持将患有PAS的妇女的护理区域化，由卓越中心或 有指定的团队和标准化的方案。然而，到目前为止，还没有 根据医院层面、甚至是医院层面的风险适当护理，系统地评估医院的结果 专门的“附着物中心”没有提供数据显示健康差距的改善。在……里面 作为对NIH改善倡议的回应，当前的提案使用加州的排放数据(2013-2016)，以 解决以下研究目标：(1)描述胎盘异常(PAS)妇女的产妇结局 或前置胎盘)按产妇护理水平和种族/民族分类；(2)评估 产妇保健和种族/民族对患有PAS的妇女的严重孕产妇发病率(SMM)的影响；以及(3)评估 产妇保健水平和种族/民族对前置胎盘妇女SMM的交互作用 可能受到母体风险影响的其他情况，适当的护理。这项研究将是第一次 评估PAS或前置胎盘的妇女是否有更好的结局，基于风险，适当的护理和 护理水平缓解了在这些高危情况下观察到的SMM差异。此外，这项研究提供了 一个研究不同临床情况的框架，其中转诊到风险适当的护理可以被评估。

Project Summary Maternal risk appropriate care has been proposed by the American College of Obstetricians & Gynecologists (ACOG), Society of Maternal Fetal Medicine (SMFM), the Centers for Disease Control (CDC) and other stakeholders as a national system-wide recommendation to improve safety in childbirth and to decrease the rising rate of maternal morbidity and mortality. ACOG, SMFM, and various other stakeholders have advocated for certifying hospitals based on hospital resources with a system ranked from I-IV where Level I has essential resources and provides care for low risk women, Level II and III takes care of intermediate risk women, and Level IV is a regional center with 24/7 access to onsite multidisciplinary consultants and critical care resources. In response to the NIH IMPROVE initiative, this supplement proposal focuses on hemorrhage--the 4th leading cause of maternal mortality. Reports suggest that upwards of 66-93% may be avoidable making it the leading cause of preventable maternal death. Abnormal placentation (placenta accreta spectrum (PAS) disorders and placenta previa) is a leading cause of hemorrhage. Rates are increasing due to increasing rates of cesarean delivery, and risk of cesarean varies by race/ethnicity. Many researchers, clinicians, and patient advocacy groups support regionalizing care for women with PAS with care coordinated by centers of excellence or "accreta centers” with designated teams and standardized protocols. However, to date, there has not been a systematic evaluation of outcomes by hospitals based on risk appropriate care at the hospital level, and even the specialized “accreta centers” have not provided data demonstrating improvement in health disparities. In response to the NIH IMPROVE initiative, the current proposal uses California discharge data (2013-2016), to address the following study aims: (1) describe maternal outcomes in women with abnormal placentation (PAS or placenta previa) by level of maternal care and race/ethnicity; (2) evaluate the interactions of levels of maternal care and race/ethnicity on severe maternal morbidity (SMM) for women with PAS; and (3) evaluate the interaction of levels of maternal care and race/ethnicity on SMM for women with placenta previa—an alternate condition that likely could be influenced by maternal risk appropriate care. This study will be the first to evaluate if outcomes are better for women with PAS or placenta previa based on risk appropriate care and if level of care mitigates observed disparities in SMM for these high-risk conditions. Further, this study provides a framework to study different clinical conditions where referral to risk appropriate care can be evaluated.