Optimizing utilization of lay health workers to address maternal and child health disparities: A Comprehensive Evaluation of a clinically integrated Breastfeeding Peer Counseling Program

母乳喂养对母婴健康有着独特而深远的益处。如果90%的美国父母- 前6个月完全母乳喂养，12个月补充母乳喂养的婴儿，2600个多余 每年可避免产妇死亡和721名婴儿死亡。尽管有这些巨大的健康益处 由于母乳喂养的好处，只有45%的美国亲生父母达到了6个月的目标，有色人种和 低收入家庭的妇女在母乳喂养成功方面面临额外的障碍， 婴儿发病率和死亡率。临床综合母乳喂养同伴咨询（ci-BPC）已被证明， 有效促进母乳喂养结果方面的种族和经济平等。尽管已经证明 尽管ci-BPC的有效性尚未得到充分证实，但在项目设计和成本方面仍存在严重的知识差距。因此 K 01申请的科学目的是评估ci-BPC计划的有效实施 并确定基本的计划活动，确定重要的患者水平和相关的背景因素 实施，并确定ci-BPC对患者，卫生系统和社会的经济影响。 弥合这些知识差距将通过提供一个框架， 执行和评价。我的中心假设是，ci-BPC咨询增加患者 母乳喂养知识和社会支持，从而增加权力和减少压力， CI-BPC所带来的母乳喂养率的提高将与医疗保健成本的降低有关 婴儿在分娩后的前6个月内使用。具体而言，我的目标是：（1）确定基本的 有效的医院ci-BPC计划的计划活动，识别相关的背景因素，并调整 优化黑人和拉丁裔患者母乳喂养结果的计划;（2）确定 调整后的ci-BPC计划在改善母乳喂养结果、态度、知识和 支持相比，标准产前护理，（3）以确定病人，程序，医疗保健，和社会 CI-BPC的成本。该项目将评估一个创新的医院为基础的ci-BPC计划在北岸 大学保健系统已证明母乳喂养的差距大大减少。我亲密 我在这个ci-BPC项目中的作用以及我在混合方法领域和临床研究方面的专业知识， 我配备了承担这样一个项目的技能，但我需要额外的指导和培训， 实施科学、临床干预研究和医疗保健经济学。培训和研究 是重要的，因为美国孕产妇和儿童健康的差距正在扩大， 对于复制和扩大促进卫生公平的干预措施至关重要。这项创新研究将 生成有关ci-BPC项目设计和ci-BPC经济影响的新数据， 实施这一干预。本申请是对SEN NOT-HS-21-014的响应：AHRQ宣布 对卫生服务研究的兴趣，以促进健康公平。

Breastfeeding provides unique and profound maternal and infant health benefits. If 90% of US parent- infant dyads breastfed exclusively for the first six months and supplemented through 12 months, 2600 excess maternal deaths and 721 infant deaths could be averted each year. Despite these substantial health benefits conferred by breastfeeding, only 45% of US birth parents meet this 6-month goal, and parents of color and those in low income families face additional barriers to breastfeeding success, resulting in double the risk of infant morbidity and mortality. Clinically-integrated breastfeeding peer counseling (ci-BPC) has been shown to effectively promote racial and economic equity in breastfeeding outcomes. Despite the demonstrated effectiveness of ci-BPC, there remain critical knowledge gaps regarding program design and costs. Thus, the scientific objective of this K01 application is to evaluate the implementation of an effective ci-BPC program and determine the essential program activities, identify significant patient-level and contextual factors relevant to implementation, and determine the economic impact of ci-BPC for patients, health systems, and society. Closing these gaps in knowledge will support wider adoption of ci-BPC by providing a framework for implementation and evaluation. My central hypothesis is that ci-BPC counselling increases patient breastfeeding knowledge and social support, leading to increased empowerment and reduced stress, and that the improvements in breastfeeding rates conferred by ci-BPC will be associated with lower cost of healthcare utilization for infants in the first 6 months post-delivery. Specifically, I aim: (1) To determine the essential program activities of an effective hospital ci-BPC program, identify relevant contextual factors, and adapt the program to optimize breastfeeding outcomes for Black and Latinx patients; (2) To determine whether the adapted ci-BPC program is more effective at improving breastfeeding outcomes, attitude, knowledge, and support compared to standard prenatal care, and (3) To determine patient, program, healthcare, and societal costs for ci-BPC. This project will evaluate an innovative hospital-based ci-BPC program at NorthShore University HealthSystem that has demonstrated significant reduction in breastfeeding disparities. My intimate role with this ci-BPC program and my expertise in mixed-methods field-based and clinical research has equipped me with the skills to undertake such a project, but I need additional mentorship and training in implementation science, clinical intervention research, and healthcare economics. The training and research are significant because disparities in maternal and child health in the US are growing, and an evidence-basis is essential to replicate and scale up interventions that promote health equity. This innovative research will generate novel data regarding ci-BPC program design and economic impact of ci-BPC that will inform broader implementation of this intervention. This application is responsive to SEN NOT-HS-21-014: AHRQ Announces Interest in Health Services Research to Advance Health Equity.