Large-scale Implementation of Community Co-led Maternal Sepsis Care Practices to Reduce Morbidity and Mortality from Maternal Infection

在美国，感染现在是直接孕产妇死亡的最常见原因，也是第三大主要原因 引起心血管疾病和其他既往疾病后的总体原因。在全国范围内，有 自1987年美国疾病控制与预防中心成立以来，感染死亡的总体百分比没有任何改善 孕产妇死亡率监测，尽管非妊娠患者的整体脓毒症护理有所改善。这个 长期目标是降低孕产妇败血症的发病率和死亡率。中心假设是 通过社区领导、解决障碍和深入实施标准化 孕期调整的筛查、诊断和治疗，将使孕产妇因感染和败血症而发病率下降 减少。该应用程序的总体目标是(I)识别基于患者和基于临床医生的障碍； (Ii)完善孕期败血症筛查；以及(Iii)实施大规模质量改进合作。 将通过追求以下具体目标来检验中心假设：UG3阶段1)开发和 支持由社区代表、患者、患者组成的母亲败血症社区领导小组 倡导者、幸存者和遇难者家属通知并进行实质性接触 在整个研究中；2A)确定护理严重孕产妇感染和败血症的以患者为基础的障碍；2B) 实施循证脓毒症的设计策略 护理干预措施，专门针对解决和克服目标2A和2B中确定的障碍；3) 建立妊娠调整产期败血症筛查的测试特征。一旦障碍被清除 确定克服它们的策略以及脓毒症的筛查、诊断和治疗护理实践 已经根据定性和定量数据进行了调整，将过渡到超高浓缩铀阶段。UH3 目标1) 确定基于临床医生的实施障碍；2C) 在加利福尼亚州和密歇根州实施改进的脓毒症筛查、诊断和治疗护理实践 并评估孕产妇发病率和死亡率的结果。这项申请中提出的研究是 创新是因为这是第一个与代表共同领导大规模产妇倡议的研究之一 来自社区、多样性、公平和包容(DEI)、患者权益倡导者代表、患者和 有败血症生活经历的家庭。这项研究意义重大，因为预计通过识别 并通过社区、临床医生、患者和Dei解决护理和实施方面的障碍 作为伙伴关系，这一大规模执行倡议将成为减少孕产妇死亡率的国家典范 这是一项关于脓毒症死亡率和发病率的研究报告，并有可能成为解决其他死亡原因的模式。

In the United States, infection is now the most common cause of direct maternal mortality and the third leading cause overall after cardiovascular conditions and other pre-existing medical conditions. Nationally, there has been no improvement in the overall percentage of deaths from infection since 1987 when the CDC began maternal mortality surveillance, despite improvements in overall sepsis care for nonpregnant patients. The long-term goal is to reduce maternal morbidity and mortality from maternal sepsis. The central hypothesis is that though community leadership, addressing barriers, and intensive implementation of standardized pregnancy-adjusted screening, diagnosis, and treatment that maternal morbidity from infection and sepsis will decrease. The overall objectives in this application are to (i) identify patient-based and clinician-based barriers; (ii) refine sepsis screening in pregnancy; and (iii) implement a large-scale quality improvement collaborative. The central hypothesis will be tested by pursuing the following specific aims: UG3 phase 1) Develop and support a Maternal Sepsis Community Leadership Group of community representatives, patients, patient advocates, and survivors and family members of those who did not survive to inform and engage substantively throughout the study; 2A) Identify patient-based barriers to care for severe maternal infection and sepsis; 2B) Design strategies to implement evidence-based sepsis care interventions, specifically targeted to address and overcome barriers identified in Aims 2A and 2B; 3) Establish test characteristics of a pregnancy-adjusted intrapartum sepsis screen. Once barriers have been identified with strategies to overcome them and the sepsis screening, diagnosis, and treatment care practices have been adjusted based on qualitative and quantitative data it will be transitioned to the UH3 phase. UH3 Aim 1) Identify clinician-based barriers to implementation; 2C) Implement refined sepsis screening, diagnostic, and treatment care practices in California and Michigan and evaluate outcomes of maternal morbidity and mortality. The research proposed in this application is innovative because it is one of the first studies to co-lead a large-scale maternal initiative with representatives from the community, diversity, equity and inclusion (DEI), patient advocate representatives, and patients and families with lived experience with sepsis. This research is significant because it is expected that by identifying and addressing barriers to care and implementation through community, clinician, patient and DEI partnerships, this large-scale implementation initiative will serve as a national model to reduce maternal mortality and morbidity from sepsis, and potentially serve as a model to address other causes of mortality.