Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality - Administrative Supplement

1美国严重的孕产妇发病率和死亡率对非裔美国人（AA）的影响尤为严重 两个女人。不平等现象发生在许多层面，包括社区、提供者/做法和卫生系统层面。的 3家长资助奖是测试的有效性和成本效益的多层次干预，以解决 4 AA密歇根州两个县的孕产妇发病率和死亡率：杰内塞县（包括弗林特）和肯特县 5县（包括大急流城）。干预措施是由我们的合作伙伴开发或共同开发的， 6个州，其中包括AA妇女居民，加强产前和产后护理（EPC）工作人员（包括种族- 7名匹配的社区卫生工作者），以及医生/卫生系统工作人员和提供者。 8在我们的工作和家长资助奖的基础上，这项补充的目标是加强 9.了解种族主义、居住隔离、其他社会决定因素（例如： 经济困难、教育）和各种其他风险因素的差异， 11产妇发病率和死亡率。这一补充将支持我们的跨学科的长期目标 12项研究方案侧重于现有产妇发病率和死亡率不成比例的负担， 13名非洲裔美国人（AA）妇女，有可能减少孕产妇中的巨大种族差异。 14发病率和死亡率，特别是AA和非西班牙裔白色（NHW）女性之间。 15.这项研究是一项新的研究，它对未得到充分研究的妇女的健康研究领域作出了贡献， 16个代表性不足和报告不足（U3）的群体，以及使用一个多层面框架， 17.采取跨学科办法解决产妇保健方面的差距。补充将增加父母 18项目的整体影响，通过产生额外的证据，这将有助于了解有效的 19项干预措施和途径，以减少孕产妇发病率和死亡率方面现有的巨大差距。 20补充将利用所有医疗补助保险的妇女谁提供资助的父母奖励数据， 21密歇根州2016-2021年（约400，000例分娩，包括121，500例非裔美国妇女的分娩）。 22将从预先存在的关联数据集中采取措施，这些数据集包括医疗补助索赔，死亡记录，出生 23条记录和家访程序数据。资助父母奖是第一批在试验中评估的奖项之一。 24.在人口一级采取多层次干预措施，降低再障孕产妇发病率和死亡率。试验测试 25.干预是否涉及假定为干预效果基础的机制， 26个成本效益数据，系统需要做出关于采用的明智决策，加速实施。 27.本补编中提出的分析将增进对干预机制的理解， 28影响通过调查众多因素的交叉点，内部和外部，影响 29产妇保健，更具体地说，产妇发病率和死亡率方面的种族差异。

1 Severe maternal morbidity and mortality in the U.S. disproportionately affect African-American (AA) 2 women. Inequities occur at many levels, including community, provider/practice, and health system levels. The 3 parent funded award is testing the effectiveness and cost-effectiveness of a multilevel intervention to address 4 AA maternal morbidity and mortality in two Michigan counties: Genesee County (which includes Flint) and Kent 5 County (which includes Grand Rapids). Interventions were developed or co-developed by our partners in these 6 counties, who include AA women residents, enhanced prenatal and postnatal care (EPC) staff (including race- 7 matched community health workers), and physician/health system staff and providers. 8 Building on our work and the parent funded award, the objective of this supplement is to enhance the 9 understanding of the intersections of racism, residential segregation, other social determinants (e.g. 10 disparities in economic hardship, education), and a variety of other risk factors, on disparities in 11 maternal morbidity and mortality. This supplement will support the long-term goal of our interdisciplinary 12 program of research focused on the disproportionate burden of maternal morbidity and mortality that exists 13 among African American (AA) women, with the potential to reduce the large racial disparities in maternal 14 morbidity and mortality, especially between AA and non-Hispanic white (NHW) women. 15 The research is novel in its contribution to the field of research on the health of women of understudied, 16 underrepresented and underreported (U3) populations and in its use of a multidimensional framework with an 17 interdisciplinary approach to address disparities in maternal health. The supplement will increase the parent 18 project's overall impact by generating additional evidence that will contribute to the understanding of effective 19 interventions and pathways to reduce the large existing disparities in maternal morbidity and mortality. 20 The supplement will leverage funded parent award data from all Medicaid insured women who deliver in 21 Michigan from 2016-2021 (approximately 400,000 births, including 121,500 births to African American women). 22 Measures will be taken from a pre-existing linked dataset that includes Medicaid claims, death records, birth 23 records, and home visiting program data. The funded parent award is among the first to evaluate in a trial a 24 multilevel intervention to reduce AA maternal morbidity and mortality at the population level. The trial tests 25 whether the intervention engages the mechanisms presumed to underlie intervention effects and provides 26 cost-effectiveness data that systems need to make informed decisions about adoption, speeding implementation. 27 The analyses proposed in this supplement will improve the understanding of the mechanisms of the intervention 28 effects by investigating the intersection of a multitude of factors, both internal and external, that influence 29 maternal health and, more specifically, the racial disparities in maternal morbidity and mortality.