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Minding the gap: a multidisciplinary approach to reducing maternal health disparities in Georgia

关注差距：减少格鲁吉亚孕产妇健康差异的多学科方法

基本信息

批准号：
10437021
负责人：
ESTHER KATHLEEN ADAMS
金额：
$ 74.11万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-14 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10437021
关键词：
Adherence Admission activity Affect Birth Caring Case Management Case Manager Cessation of life Chronic Clinical Collaborations Communities Complex Computerized Medical Record Contraceptive methods Data Developed Countries Diabetes Mellitus Enrollment Ethnic Origin Ethnic group Evaluation Familiarity Family Planning Family Planning Programs Foundations Future Gestational Diabetes Guidelines Health Health Care Visit Health Personnel Health Services Research Health system Healthcare Healthcare Systems Hospitalization Hospitals Hypertension Improve Access Individual Institution Insurance Intervention Interview Knowledge Link Location Low income Maternal Health Maternal Health Services Maternal Mortality Medicaid Medical Methods Mind Minority Women Mothers National Institute on Minority Health and Health Disparities Not Hispanic or Latino Obesity Outcome Outcome Assessment Outcome Measure Participant Pharmaceutical Preparations Policies Politics Postpartum Period Postpartum Women Pregnancy Pregnancy Complications Pregnant Women Prenatal care Prevalence Primary Health Care Process Measure Provider Race Randomized Records Research Resources Review Committee Risk Risk Factors Services Site Social support State Hospitals System Time Translating Uninsured Variant Very Low Birth Weight Infant Visit Woman Work adverse outcome base cardiometabolism cardiovascular risk factor care fragmentation care outcomes care systems design disparities in morbidity disparity reduction ethnic difference experience follow-up health care service utilization health disparity high risk hospital readmission improved inner city insight interdisciplinary approach maternal morbidity multidisciplinary outreach patient oriented postpartum care pregnancy hypertension prenatal preventable death preventive intervention programs racial and ethnic racial and ethnic disparities racial disparity randomized trial safety net severe maternal morbidity social social structure standard care standard of care success systematic review

项目摘要

PROJECT SUMMARY The US maternal mortality ratio (26.4 maternal deaths per 100,000 livebirths) is the highest among developed nations, with wide variation across states and racial/ethnic groups. The state of Georgia has the second highest maternal mortality (66.3 per 100,000), with a 60% higher rate for black vs white women (95.6 vs 59.7 per 100,000). Nearly 100 times more common than maternal mortality, however, is severe maternal morbidity (SMM). Maternal mortality and SMM are highest among women who are black, publicly insured or uninsured, and deliver in safety-net hospitals. In Georgia, nearly two-thirds of maternal deaths and SMM are deemed preventable, with chronic health conditions, obesity, delays in accessing and fragmentation of care as key contributors. Current data indicate that postpartum SMM is increasing at a faster rate than SMM during the delivery hospitalization. Proposed solutions to the maternal health crisis in Georgia include improved prenatal and postpartum follow-up and case management, control of chronic health conditions, and extension of Medicaid coverage. However, there is a dearth of evidence regarding whether such strategies can improve maternal health or reduce racial disparities in SMM or mortality. The proposed study will begin to fill this void with a multidisciplinary, mixed-methods approach. We will first analyze Georgia linked vital records, hospital discharge, and claims data to provide an overview of the extent, location and determinants of differences in SMM among non-Hispanic black and non-Hispanic white women at delivery and 3 to 12 months postpartum. Using regression-based decomposition methods we will highlight the portions of the racial/ethnic differences explained by observable and unobservable factors. We will use these findings and in-depth interviews with postpartum women and their health care providers and case managers to contextualize the analysis of two postpartum interventions targeting women at risk for adverse outcomes – an existing Medicaid policy and a newly designed health system intervention. The Georgia Medicaid Planning for Healthy Babies (P4HB) Medicaid program provides postpartum women with a very low birth weight delivery primary care inclusive of nurse case management and Resource Mother outreach to link women to social supports. This study will be the first to evaluate the effects of this Medicaid policy on SMM disparities. These analyses will then be used to inform the design of the new postpartum care system for women who deliver at a safety-net hospital in Atlanta, Georgia, and are at increased risk for SMM. Women (N = 320) will be randomly assigned to either this enhanced postpartum care system vs. standard care, with assessment of outcomes within 12 weeks and 12 months postpartum, including attendance of postpartum care visits, receipt of recommended care, and adverse outcomes such as hospital readmissions. The insights gained from the proposed work will fill critical knowledge gaps regarding policy and practice approaches for reducing maternal health disparities and can serve as a foundation for future prevention and intervention strategies within the state and nationally.

项目概要美国的孕产妇死亡率（每 10 万活产中有 26.4 名孕产妇死亡）是发达国家中最高的国家，各州和种族/族裔群体之间存在很大差异。佐治亚州位居第二孕产妇死亡率最高（每 10 万人中有 66.3 人），黑人妇女的死亡率比白人妇女高 60%（95.6 人比 59.7 人）每 100,000 人）。然而，严重的孕产妇发病率比孕产妇死亡率高近 100 倍（SMM）。黑人、公共保险或未保险女性的孕产妇死亡率和 SMM 最高，并在安全网络医院中分娩。在佐治亚州，近三分之二的孕产妇死亡和 SMM 被认为是可预防的，其中慢性健康问题、肥胖、获得护理服务的延迟和分散化是关键贡献者。目前的数据表明，产后 SMM 的增长速度快于产后 SMM 的增长速度。分娩住院。格鲁吉亚孕产妇健康危机的拟议解决方案包括改善产前服务产后随访和病例管理、慢性健康状况的控制以及延长医疗补助覆盖范围。然而，缺乏证据表明这些策略是否可以改善孕产妇健康或减少 SMM 或死亡率方面的种族差异。拟议的研究将开始填补这一空白采用多学科、混合方法的方法。我们将首先分析佐治亚州相关的生命记录、医院排放和索赔数据，以概述差异的程度、位置和决定因素 SMM 在非西班牙裔黑人和非西班牙裔白人女性中进行，包括分娩时和产后 3 至 12 个月。使用基于回归的分解方法，我们将突出显示种族/民族差异的部分由可观察和不可观察因素解释。我们将利用这些发现和深入访谈产后妇女及其医疗保健提供者和案例管理者对两个问题进行背景分析针对面临不良后果风险的女性的产后干预措施——现有的医疗补助政策和新设计的卫生系统干预措施。乔治亚州健康婴儿医疗补助计划 (P4HB) 医疗补助计划为产后妇女提供极低出生体重的初级保健，包括护士案例管理和资源母亲外展活动将妇女与社会支持联系起来。这项研究将第一个评估医疗补助政策对 SMM 差异的影响。这些分析随后将用于为在亚特兰大安全网医院分娩的妇女设计新的产后护理系统提供信息，乔治亚州，SMM 风险增加。女性 (N = 320) 将被随机分配到以下任一组强化产后护理系统与标准护理相比，在 12 周内和 12 周内评估结果产后几个月，包括参加产后护理就诊、接受建议的护理以及不良反应结果如再次入院。从拟议工作中获得的见解将填补关键知识减少孕产妇健康差异的政策和实践方法方面的差距，可以作为为州内和全国范围内未来的预防和干预战略奠定基础。