Reducing Racial Disparities in SMM post COVID19: Assessing the integration of maternal safety bundles and community based doulas to improve outcomes for Black women

COVID19 后减少 SMM 中的种族差异：评估孕产妇安全包和社区导乐的整合，以改善黑人妇女的结局

• 批准号: 10426351
• 负责人: NDIDIAMAKA AMUTAH-ONUKAGHA
• 金额: $ 61.75万
• 依托单位: TUFTS UNIVERSITY BOSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-17 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426351
• 关键词: Address; Area; Attitude; Biological; Birth; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Color; Communities; Data; Data Collection; Data Linkages; Data Sources; Development; Discipline of obstetrics; Ensure; Ethnic Origin; Ethnic group; Focus Groups; Foundations; Future; Health; Health Personnel; Hemorrhage; High Prevalence; High Risk Woman; Hispanic; Hospitalization; Hospitals; Hypertension; Individual; Information Systems; Intervention; Interview; Investigation; Life; Link; Live Birth; Massachusetts; Maternal Health; Maternal Mortality; Medical Care Team; Methods; Modeling; Morbidity - disease rate; Mothers; National Institute on Minority Health and Health Disparities; Not Hispanic or Latino; Outcome; Pattern; Perinatal Care; Population; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal care; Provider; Public Health; Race; Recommendation; Reporting; Research; Review Committee; Risk; Services; System; Testing; Time; United States; Woman; Women' s Group; Women' s Health; base; black women; design; disparity reduction; effectiveness evaluation; ethnic minority; experience; health care service utilization; health disparity; health inequalities; hybrid type 1 trial; implementation evaluation; implementation framework; implementation outcomes; implementation process; implementation science; improved; improved outcome; innovation; longitudinal design; maternal outcome; maternal safety; mortality; mortality disparity; obstetric care; peer; post-COVID-19; postpartum care; prenatal; prevent; preventable death; programs; racial disparity; racial minority; scale up; secondary analysis; severe maternal morbidity; tool

Abstract (Project Summary) Black women experience stark disparities in pregnancy care, complications, and outcomes, compared to White women. Recognizing, tracking and understanding patterns of severe maternal mortality (SMM) and associated inequities by race/ethnicity, along with developing and carrying out interventions to improve the quality of maternal care, are essential to reducing SMM and thereby maternal mortality. To date, there has been little research specifically aimed at understanding whether the maternal health inequities as experienced by Black women can be ameliorated through an integrated care model that includes engagement of mothers of color in the planning and implementation of maternal safety bundles in addition to prenatal, birth and postpartum support from community doulas. We intend to use the Health Impact Pyramid to develop, implement and assess the effectiveness of such a system in reducing disparities in SMM and mortality. The data sources for this study will include state-level and hospital-specific discharge data collected as part of the Alliance for Innovation on Maternal Health (AIM) project; the Maternal Mortality Review Committee (MMRC); and the Pregnancy to Early Life Longitudinal (PELL) data system, which focuses on population-level data needed to examine health inequities among racial and ethnic minorities in Massachusetts. In addition to these existing data sources, we intend to establish a data collection tool to assess doula services as well as analyze qualitative data from interviews with black women, and focus groups with providers and doulas to explore the effect of incorporating doula-provided services into prenatal, birth and postpartum care. This proposal has three main study areas that will lead to a systematic understanding of ways to address and prevent SMM among black women and thus, establish a foundation for the development, testing and scale-up of future interventions to improve maternal health outcomes: 1) Use longitudinally linked hospital discharge data from PELL (2008-2018) to characterize preconception, prenatal and postpartum hospital encounters among women with SMM in order to identify key points where opportunities to intervene were missed. 2): Among hospitals that serve black women, to assess the impact of implementing maternal safety bundles to ensure that black women are receiving quality obstetric care 3): Examine how systems integrating community-based doula support could decrease the inequities of SMM among black and white mothers. Our study will lead to a more systematic understanding of pregnancy outcomes for Black women at highest risk of SMM, thus establishing a foundation for development and testing of future interventions to improve maternal outcomes.

摘要（项目总结）