A Systems Investigation of Maternal Care

孕产妇护理的系统调查

• 批准号: 10218800
• 负责人: Dulaney A. Wilson
• 金额: $ 10万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-03-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218800
• 关键词: Systems; Investigation; Maternal; Care

PROJECT SUMMARY Despite having the most expensive maternity care in the world, the maternal mortality rate (MMR) in the US increased to 16.9 deaths per 100,000 live births in 2017, with estimates as high as 26.4 in 2015. For every maternal death there are 50 - 100 cases of severe maternal morbidity (SMM) and this rate has also increased sharply – rising 45% between 2006 and 2015. Women of color are more likely to suffer mortality and SMM; Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Maternal mortality and SMM cost billions of dollars each year. However, 45 – 60% of all maternal deaths and SMM are preventable with timely and appropriate care. Thus, disparities in mortality and SMM are not only related to individual-level variables but also to multilevel contributors, which suggests that there are opportunities to improve health service quality. Examination of the structures and processes of care would help uncover challenges in the clinical systems that contribute to poor maternal care and disparities and identify also features of the system of care that are amenable to interventions. Despite 20 years of systems research in healthcare, few studies have examined the contribution of clinical systems to adverse outcomes and disparities in maternal care. Initial observations in the maternal care units - antepartum, labor and delivery (L&D), and postpartum - and review of patient safety incidences identified a range of systems issues such as understaffing, extensive use of inexperienced contract nurses, missing equipment and supplies, and malfunctioning equipment, that impacted patient care. Preliminary analysis of 19 months of administrative data found that the hospital’s L&D unit delivered 4,057 patients, an average of 225.39 patients each month, and the cesarean delivery rate was 38%. There were 45 readmissions during this period, 15 recorded cases of SMM (hemorrhage, hysterectomy, and abscess) and one maternal death. This data was not disaggregated by race. This research proposes a mixed methods approach to investigate systems safety and equity by conducting a prognostic risk assessment and examining distributions of incidents as a preliminary assessment of disparate care. This research will describe, in more detail than has ever been available before, how the clinicians delivering maternal care are predisposed to success or failure by the design of the work system and offer a reasonable approximations of disparate quality of care in the health system. Specifically, the following three aims will be conducted: AIM 1: Develop a sociotechnical systems model of maternal care using a work systems analysis; AIM 2: Examine risks in maternal care units using patient safety incident reports; and AIM 3: Identify sociotechnical factors contributing to disparities in adverse events in maternal care. This research coalesce patient safety and disparities efforts to generate and test hypotheses that will ultimately lead to multi- level interventions that can be tailored for local implementation and scaled for widespread adoption.

项目摘要 尽管拥有世界上最昂贵的孕产妇保健，但美国的孕产妇死亡率（MMR） 2017年增加到每10万例活产死亡16.9例，2015年估计高达26.4例。每 产妇死亡有50 - 100例产妇严重发病，这一比率也有所上升 在2006年至2015年期间大幅增长了45%。有色人种女性更容易死亡和SMM; 黑人妇女死于妊娠相关原因的可能性是白色妇女的3至4倍。产妇 死亡率和SMM每年花费数十亿美元。然而，45 - 60%的孕产妇死亡和孕产妇死亡率是由以下原因造成的： 通过及时和适当的护理可以预防。因此，死亡率和最低有效管理率的差异不仅与以下因素有关： 个人层面的变量，但也多层次的贡献者，这表明有机会， 提高卫生服务质量。检查护理的结构和过程将有助于揭示 临床系统面临的挑战，这些挑战导致孕产妇护理不良和差异，并确定 护理系统的特点，是服从干预措施。尽管20年的系统研究， 在医疗保健方面，很少有研究检查临床系统对不良结局和差异的贡献 在产妇护理中。在孕产妇保健单位进行的初步观察-产前、分娩和分娩，以及 产后-和患者安全事件的审查确定了一系列系统问题，如 人手不足，大量使用缺乏经验的合同护士，缺少设备和用品， 设备故障，影响了病人护理。对19个月行政数据的初步分析 发现医院的L&D部门交付了4，057名患者，平均每月225.39名患者， 剖宫产率为38%。在此期间有45例再入院，15例记录的SMM病例 （出血、子宫切除术和脓肿）和1例孕产妇死亡。这些数据没有按种族分列。 本研究提出了一种混合方法的方法来调查系统的安全性和公平性，通过进行 预测风险评估和检查事件的分布，作为对不同事件的初步评估。 在乎这项研究将比以往任何时候都更详细地描述，临床医生如何 提供产妇护理的妇女的成功或失败取决于工作制度的设计， 合理地近似卫生系统中不同的护理质量。具体来说，以下三个 目标1：利用一项工作，建立一个产妇护理的社会技术系统模式， 系统分析;目标2：使用患者安全事件报告检查孕产妇护理单位的风险;目标3： 确定社会技术因素，导致孕产妇护理不良事件的差异。本研究 整合患者安全和差异，以生成和测试最终导致多个 这些干预措施可以针对当地实施情况进行调整，并可扩大规模以广泛采用。

项目成果

Racial and ethnic disparities in long-term contraception use among the birthing population at an academic hospital in the Southeastern United States.

• DOI: 10.1177/21695067231192873
• 发表时间: 2023-09
• 期刊: Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting. Human Factors and Ergonomics Society. Annual meeting
• 作者: Akintunde, Tosin;Howard, Jeffrey;Wilson, Dulaney;Gore, Amartha;Morton, Christine;Hebbar, Latha;Goodier, Chris;Alfred, Myrtede C
• 通讯作者: Alfred, Myrtede C