Caring for Providers to Improve Patient Experience (CPIPE) Study

关爱医疗服务提供者以改善患者体验 (CPIPE) 研究

• 批准号: 10556284
• 负责人: Patience A Afulani
• 金额: $ 65.29万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10556284
• 关键词: Address; Africa South of the Sahara; Automobile Driving; Behavior; Birth; Caring; Cessation of life; Childbirth; Cost Analysis; Cost Effectiveness Analysis; Country; Cross-Sectional Studies; Data; Disparity; Distal; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Emergency Situation; Environment; Equity; Evidence based intervention; Facility Controls; Feedback; Future; Ghana; Grant; Health behavior and outcomes; Health care facility; Inequity; Intervention; Interview; Kenya; Knowledge; Leadership; Maternal Health; Maternal Mortality; Measures; Mediation; Mentorship; Methods; Modeling; Morbidity - disease rate; Mothers; Outcome; Patients; Persons; Pilot Projects; Prevalence; Process; Provider; Randomized, Controlled Trials; Research; Self Efficacy; Socioeconomic Status; Stress; Surveys; System; Time; Training; Trauma; Woman; Women Status; behavior change; burnout; care providers; care seeking; cost; cost effectiveness; design; effectiveness evaluation; effectiveness testing; experience; health seeking behavior; improved; innovation; intervention effect; low and middle-income countries; low socioeconomic status; maternal morbidity; maternal outcome; mortality; neonatal care; neonatal health; neonatal outcome; obstetric care; peer support; person centered; preference; pregnancy related death; primary outcome; simulation; skills; social cognitive theory; theories

PROJECT SUMMARY: An estimated 800 pregnancy-related deaths occur daily. Most of these deaths occur in low- and middle-income countries (LMICs), with about two-thirds in sub-Saharan Africa (SSA) alone. Skilled care in health facilities is critical to improving maternal and neonatal outcomes. Yet, only about two-thirds of births in SSA occur in health facilities—with wide disparities, especially by socioeconomic status (SES). Poor person-centered maternal care (PCMC) is a key driver of both the low rates of facility-based deliveries and disparities. Further, where facility-based childbirth rates have increased, poor PCMC leads to morbidity and mortality due to delayed, inadequate, unnecessary, or harmful care. Yet, there is limited research on interventions to improve PCMC in LMICs; and existing interventions do not explicitly address inequities in PCMC experiences. To address this gap, we designed the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention to address drivers of poor PCMC and center the unique needs of vulnerable women in LMICs. CPIPE is a theory and evidence-based intervention with 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training is a simulation-based curriculum that integrates content on PCMC, stress, burnout, and bias into emergency obstetric and neonatal care drills. We target provider stress and bias because they are mutually reenforcing factors driving poor and inequitable PCMC. The other intervention components create an enabling environment for behavior change. Our pilot studies show high feasibility, acceptability, and preliminary effectiveness. We therefore propose a cluster randomized-controlled trial, in 40 high-volume delivery health facilities in Kenya and Ghana, to assess the impact of CPIPE on PCMC and intermediate and distal outcomes in our conceptual model. We will accomplish this through 3 aims. Aim 1: to assess the effectiveness of the CPIPE intervention on PCMC in Kenya and Ghana. We hypothesize that CPIPE will improve PCMC for all women, and especially for low SES women. Our primary outcome is PCMC measured with the PCMC scale through multiple cross-sectional surveys of mothers who gave birth in the preceding 9 weeks in study facilities at baseline (prior to intervention), midline (6 months post-baseline), and endline (12 months post-baseline) (N=2000 at each time point). A sub-aim 1 will assess the cost-effectiveness of CPIPE. Aim 2: to examine the mechanisms of impact of CPIPE on PCMC. We will assess the effect of CPIPE on intermediate outcomes such as provider knowledge, self-efficacy, stress, burnout, and bias levels; and conduct mediation analysis to assess if changes in these outcomes account for the effect of CPIPE on PCMC. Aim 3: to assess impact of the CPIPE intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health; and examine if changes in PCMC account for these effects.

项目概要： 据估计，每天有800人因怀孕死亡。其中大多数死亡发生在低收入和中等收入国家， 这些国家中有三分之二是中低收入国家，其中约三分之二在撒哈拉以南非洲。医疗机构的熟练护理是 这对改善孕产妇和新生儿的预后至关重要。然而，撒南非洲只有大约三分之二的出生发生在 卫生设施-差距很大，特别是按社会经济地位划分。穷人中心主义 产妇护理是导致住院分娩率低和存在差异的主要原因。此外，本发明还 在设施分娩率增加的地方，由于以下原因， 延迟、不充分、不必要或有害的护理。然而，关于改善的干预措施的研究有限。 现有的干预措施并没有明确解决在PCMC经验的不平等。到 为了解决这一差距，我们设计了“关怀提供者以改善患者体验”（CPIPE）干预措施 解决贫穷的PCMC的驱动因素，并将弱势妇女的独特需求集中在中低收入国家。CPIPE是一个 基于理论和证据的干预，包括5个组成部分：提供者培训，同伴支持，指导， 嵌入式冠军和领导参与。培训是一个基于模拟的课程， 将PCMC、压力、倦怠和偏见的内容整合到紧急产科和新生儿护理训练中。我们 目标提供者压力和偏见，因为它们是造成贫穷和不公平的相互强化的因素 PCMC。其他干预措施为行为改变创造了有利环境。我们的飞行员 研究表明，可行性、可接受性和初步有效性较高。因此，我们建议将 随机对照试验，在肯尼亚和加纳的40个高容量分娩卫生设施，以评估 在我们的概念模型中，CPIPE对PCMC以及中间和远端结局的影响。要全面完成 通过三个目标。目标1：评估CPIPE对肯尼亚PCMC干预的有效性， 加纳.我们假设CPIPE将改善所有女性的PCMC，尤其是低SES女性。我们 主要结果是通过对母亲的多个横断面调查，用PCMC量表测量PCMC 在基线（干预前）、中线（6个月）和基线（6个月）时， 基线后）和终点（基线后12个月）（每个时间点N=2000）。次级目标1将评估 CPIPE的成本效益。目的2：探讨CPIPE对PCMC的影响机制。我们将 评估CPIPE对中间结果的影响，如提供者的知识，自我效能，压力， 职业倦怠和偏见水平;并进行调解分析，以评估这些结果的变化是否会导致 CPIPE对PCMC的影响。目的3：评估CPIPE干预对远端结局的影响，包括 孕产妇就医行为与孕产妇和新生儿健康的关系;并检查PCMC账户是否发生变化 对于这些影响。