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。 在心血管疾病和其他既存疾病之后，在全国范围内， 自1987年疾病预防控制中心开始以来， 孕产妇死亡率监测，尽管改善了非妊娠患者的整体脓毒症护理。的 长期目标是降低产妇败血症的发病率和死亡率。核心假设是 虽然社区领导，解决障碍，并密集实施标准化的 妊娠调整的筛查、诊断和治疗， 减少。本申请的总体目标是（i）识别基于患者和基于临床医生的障碍; (ii)完善妊娠期脓毒症筛查;（iii）实施大规模质量改进协作。 中心假设将通过追求以下具体目标进行测试：UG 3阶段1）开发和 支持产妇败血症社区领导小组的社区代表，病人，病人 倡导者、幸存者和遇难者家属提供信息并进行实质性参与 在整个研究期间; 2A）确定基于患者的严重母体感染和脓毒症护理障碍; 2B） 设计策略以实施循证脓毒症 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） 建立妊娠调整产时脓毒症筛查的试验特征。一旦障碍物 确定了克服它们的策略以及脓毒症筛查、诊断和治疗护理实践 已根据定性及定量数据进行调整，其将过渡至UH 3阶段。UH3 目标1） 确定基于临床医生的实施障碍; 2C） 在加州和密歇根州实施完善的脓毒症筛查、诊断和治疗护理实践 并评估产妇发病率和死亡率的结果。本申请中提出的研究是 创新，因为它是与代表共同领导大规模孕产妇倡议的首批研究之一 来自社区，多样性，公平和包容性（DEI），患者倡导代表和患者， 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解决护理和实施的障碍 这一大规模的实施举措将成为减少孕产妇死亡率的国家模式， 死亡率和败血症的发病率，并可能作为解决其他死亡原因的模型。

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.