Enhancing Perinatal Care Support to Improve Maternal Mortality Disparities

加强围产期护理支持以改善孕产妇死亡率差异

基本信息

批准号：
10317866
负责人：
MELISSA A. SIMON
金额：
$ 62.23万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-24 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10317866
关键词：
Address American College of Obstetricians and Gynecologists Area Birth Black, Indigenous, People of Color Cardiovascular system Caring Chicago Child Collaborations Communities Community Health Aides Developed Countries Discipline of obstetrics Discrimination Emergency Situation Emotional Failure Feedback Fostering Goals Guidelines Guns Health Healthcare Systems High-Risk Pregnancy Home Hospitals Hybrids Institutional Racism Intervention Knowledge Lead Maternal Health Maternal Mortality Medical Medical Care Team Medical center Mental Depression Mental Health Modeling Opioid Outcome Patient Care Patients Perception Perinatal Care Personal Satisfaction Persons Postpartum Period Postpartum Women Practical, Robust Implementation and Sustainability Model Pregnancy Pregnancy Complications Pregnant Women Prenatal care Public Health Qualitative Methods Quality of Care Resources Role Safety Self Efficacy Service delivery model Site Social support Substance abuse problem Support Groups Symptoms Testing Time Underserved Population Uninsured Variant Visit Woman Women&apos s Health Work black women care coordination cohesion compare effectiveness distrust effectiveness-implementation randomized trial experience group intervention health care availability health care delivery health care quality health disparity high risk implementation intervention improved individual patient innovation intervention effect intimate partner violence low and middle-income countries maternal morbidity maternal outcome medically underserved mortality disparity perinatal period postpartum care pregnant primary outcome racial and ethnic racial and ethnic disparities racism randomized trial secondary outcome severe maternal morbidity skills social health determinants standard care telehealth uptake virtual

项目摘要

ABSTRACT Persistent and worsening racial and ethnic disparities in severe maternal morbidity and mortality in the US are urgent public health concerns requiring innovative, sustainable solutions. The perinatal period, the time before and after birth, has important implications for a woman’s health and that of her child. Unfortunately, standard perinatal care fails to meet the needs of women from Black, Indigenous and People of Color (BIPOC) communities, especially with consideration to the Social Determinants of Health (SDoH) and the systemic racism that drive health disparities. Doula care is increasingly recommended to support high-risk BIPOC women during labor and the immediate postpartum period and is posited to mitigate the effects of racism and SDoH in underserved populations. However, a key limitation to doula care is that doulas are largely relegated to working in parallel with the healthcare team and the potential consequences of this include disjointed care coordination and missed opportunities to improve healthcare quality for BIPOC women. Building on our team’s prior and current work optimizing perinatal care for medically underserved women, we will develop and evaluate a Well- Mama intervention in 3 participating medical centers in Chicago IL, Baton Rouge LA, and Newark NJ which have some of the highest US rates of maternal morbidity and mortality. The Well-Mama intervention is centered on uninsured and publicly insured pregnant and postpartum BIPOC women supported by Community Doula Navigators (CDNs) who will conduct in-person and telehealth wellness check-ins using the Well-Mama safety checklist; make referrals to resources following the check-ins, with feedback provided to the perinatal care team; lead virtual pregnancy and postpartum support groups; attend select patient visits; and provide labor support. The Well-Mama checklist includes 5 priority topic areas representing leading factors in maternal morbidity and mortality in which to attune doulas and their patients: (a) mental health/depression; (b) cardiovascular symptoms; (c) safety (e.g., guns at home and intimate partner violence); (d) opioid/substance abuse; and (e) social support, self-agency, and well-being. Well-Mama advances a Shared Care Model approach to health care delivery focused on interprofessional collaboration in relation to centering care on the individual patient. Through a Hybrid Type 1 randomized effectiveness-implementation trial of N=576 women, we will compare the effectiveness of the Well-Mama intervention relative to standard perinatal care in improving women’s receipt of recommended care components (primary outcome), reducing patient medical distrust and experience of racism/discrimination, increasing health engagement, self-efficacy, and perception of care team quality, and enhancing perinatal care team cohesion (secondary outcomes), while evaluating intervention implementation. Results will optimize doula integrated perinatal care to address the top drivers of maternal morbidity and mortality with the goal of reducing maternal health disparities experienced by pregnant and postpartum BIPOC women.

抽象的美国严重的母亲发病率和死亡率中的种族和种族差异是持续的，令人担忧的是紧急的公共卫生问题需要创新，可持续的解决方案。围产期，之前的时间出生后，对女人的健康和孩子的健康具有重要意义。不幸的是，标准围产期护理无法满足来自黑人，土著和有色人种的妇女的需求（BIPOC）社区，特别是考虑到健康的社会决定因素（SDOH）和系统性种族主义那推动健康分布。越来越建议使用Doula护理来支持高风险的Bipoc妇女劳动和产后直接时期，并张贴以减轻种族主义和SDOH的影响服务不足的人群。但是，对杜拉斯的关键局限性是导杜拉斯主要与工作有关与医疗团队同时以及这可能的后果包括分离的护理协调并错过了改善BIPOC妇女医疗保健质量的机会。在我们团队的先前和当前的工作优化医疗服务不足的妇女的围产期护理，我们将开发和评估一个很好的妈妈干预3个在芝加哥伊利诺伊州，巴吞鲁日（Baton Rouge LA）和纽瓦克（Newark NJ）美国孕产妇发病率和死亡率最高的一些。井妈妈干预以没有保险和公开保险的怀孕和产后BIPOC妇女由社区杜拉（Community Doula）支持 Navigators（CDN）将使用Well-Mama安全进行面对面和远程医疗保健清单；在签到之后向资源转介，并向围产期护理团队提供反馈；铅虚拟怀孕和产后支持小组；参加精选的患者访问；并提供劳动支持。 Well-Mama清单包括5个优先主题领域，代表孕产妇发病率的主要因素 doulas及其患者的死亡率：（a）心理健康/抑郁；（b）心血管符号；（c）安全（例如，在家中的枪支和亲密伴侣暴力）；（d）阿片类药物/药物滥用；（e）社会支持，自我机构和福祉。 Well-Mama推进了共享护理模型的医疗保健方法专注于专业间协作，与对个体患者的核心护理有关。通过混合动力 1型N = 576名女性的1型随机有效性试验，我们将比较夫人妈妈的干预相对于标准围产期护理，以改善妇女收到推荐的妇女护理组成部分（主要结果），减少患者的医疗不信任和种族主义/歧视的经验，提高健康参与度，自我效能感和对护理团队质量的看法，并增强围产期护理团队凝聚力（次要结果），同时评估干预实施。结果将优化doula 综合围产期护理以解决孕产妇发病率和死亡率的最高驱动因素，以减少孕妇和产后BIPOC妇女经历的孕产妇健康差异。