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

• 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
• 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' 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

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.

摘要 在美国，严重孕产妇发病率和死亡率方面持续和恶化的种族和民族差异是 迫切的公共卫生问题需要创新的、可持续的解决方案。围产期，早产期 而且在出生后，对妇女和她的孩子的健康有重要的影响。不幸的是，标准 围产期护理不能满足黑人、土著和有色人种妇女(BIPOC)的需求 社区，特别是考虑到健康的社会决定因素和系统性种族主义 这导致了健康差距。导乐护理被越来越多地推荐用于支持高危BIPOC妇女 分娩和产后即刻，并被认为可以减轻种族主义和SDoH在 服务不足的人群。然而，助产士护理的一个关键限制是，助产士在很大程度上被降级到工作岗位上。 与医疗团队并行，其潜在后果包括护理协调脱节 并错失了提高BIPOC女性医疗质量的机会。建立在我们团队之前和 目前的工作是优化医疗服务不足的妇女的围产期护理，我们将开发和评估良好的- 妈妈在芝加哥伊利诺伊州、巴吞鲁日洛杉矶和新泽西州纽瓦克的3个参与医疗中心的干预 产妇发病率和死亡率是美国最高的。Well-Mama干预的中心是 社区多拉支持的未参保和公共参保的孕妇和产后BIPOC妇女 将使用Well-Mama安全进行面对面和远程健康检查的导航员(CDN) 检查表；在登记后转介资源，并向围产期护理团队提供反馈； 领导虚拟怀孕和产后支持小组；参加选定的患者探视；并提供分娩支持。 Well-Mama清单包括5个优先主题领域，代表孕产妇发病率和 杜拉及其患者的死亡率：(A)精神健康/抑郁；(B)心血管症状； (C)安全(例如，家庭枪支和亲密伴侣暴力)；(D)阿片类药物/药物滥用；和(E)社会支持， 自我约束和幸福。Well-Mama提出了一种共享医疗模式的方法来提供医疗服务 专注于以患者个体为中心的跨专业协作。通过混合解决方案 1型随机有效性--对N=576名女性的实施试验，我们将比较 规范围产期保健的健康妈妈干预对提高妇女接受建议的影响 保健部分(主要成果)，减少患者在医疗方面的不信任和遭受种族主义/歧视的经历； 提高健康参与度、自我效能和对护理团队质量的感知，并加强围产期护理 团队凝聚力(次要结果)，同时评估干预实施情况。结果将优化导乐 综合围产期保健，以解决孕产妇发病率和死亡率的主要驱动因素，目标是减少 孕期和产后BIPOC妇女的孕产妇健康差异。