Improving the Quality of Prenatal Care for Low-Income, Black Women

提高低收入黑人女性的产前护理质量

• 批准号: 10557518
• 负责人: Sharla Annette Smith
• 金额: $ 24.24万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-11 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557518
• 关键词: Address; Adherence; Adoption; American College of Obstetricians and Gynecologists; Area; Aspirin; Birth; Black race; Blood Pressure; Blood Pressure Monitors; Caring; Cessation of life; Child Care; Chronic; Clinic; Clinical; Computer software; Counseling; Data; Dose; Education; Effectiveness; Equity; Evidence based program; Evidence based treatment; Feedback; Geography; Goals; Guidelines; Health; Health behavior; High Risk Woman; Hybrids; Hypertension; Incidence; Income; Individual; Insurance; Intention; Intervention; Low income; Maintenance; Maternal Health; Maternal Health Services; Maternal Mortality; Modeling; Monitor; Outcome; Patient Self-Report; Patients; Perception; Persons; Populations at Risk; Practical Robust Implementation and Sustainability Model; Pre-Eclampsia; Pregnancy; Pregnant Women; Prenatal care; Prevention; Prevention trial; Process; Proteinuria; Provider; Randomized; Recommendation; Recording of previous events; Reduce health disparities; Reproduction; Research; Research Design; Risk; Risk Factors; Rural; Self Care; Services; Site; Telemedicine; Time; Transportation; Underserved Population; Uninsured; Visit; Woman; Work; acceptability and feasibility; barrier to care; black patient; black women; blood pressure elevation; cost; design; early onset; effectiveness evaluation; empowerment; evidence base; health care disparity; health disparity; hypertension control; implementation barriers; implementation evaluation; implementation measures; implementation outcomes; implementation science; improved; innovation; medically underserved; medication compliance; metropolitan; novel; patient-level barriers; pilot test; pregnancy disorder; pregnancy health; prevent; preventable death; programs; provider-level barriers; racial disparity; recruit; telehealth; treatment as usual; treatment disparity; trend; underserved area

PROJECT SUMMARY/ABSTRACT: PROJECT 5 (SMITH) Background: The U.S. has the highest rate of maternal deaths in the developed world and over 60% of maternal deaths in the U.S. are preventable. Preeclampsia, a disorder of pregnancy characterized by hypertension and proteinuria, is a top preventable cause of maternal death and an important driver of health disparities in the U.S. Chronic hypertension, a major risk factor for preeclampsia, is estimated to be present in 3% to 5% of all pregnancies but is 60% more prevalent in Black women. Black women carry a 3- to 4-fold greater risk, compared to Whites, of dying from preeclampsia. Research suggest that women at high-risk for preeclampsia recieve 81 to 150 mg of aspirin and counseling on and self-monitor their high blood pressure between 11-16 until 36 weeks of gestation. The brief duration of typical prenatal visits (10 minutes on average) hinders the provider’s ability to deliver evidence-based preeclampsia education and counseling. To date, current research does not, moreover, take advantage of innovative and evidence-based models of prenatal care and hypertension control that have proven feasible for providers and patients. Thus, there is a critical need to implement and deliver guideline-consistent preeclampsia prevention in a sustainable model that removes barriers to care for at-risk Black women. Study Design: The long-term goal of this project is to reduce needless preeclampsia and preeclampsia-related deaths among Black pregnant women by increasing access to evidence-based care. The objective of this study is to refine and pilot test a novel intervention that is designed to address patient and provider barriers to preeclampsia prevention. The intervention, Centering HER (Health, Empowerment, and Reproduction), combines a well-established and effective group prenatal care model—Centering Pregnancy—with a promising telemedicine-based hypertension control program—Take Control of Your Blood Pressure. To meet our study objective, the study proposes the following specific aims: 1) To gain end-user input on the feasibility and acceptability of Centering HER, 2) To pilot the revised Centering HER and collect feasibility and intermediate outcome data, and 3) To determine the effectiveness of Centering HER to improve blood pressure monitoring, aspirin adherence, and implementation measures. Potential Impact: The successful completion of the aims will be important to address the cornerstones of preeclampsia prevention –prenatal care, medication adherence, and blood pressure monitoring and reduce maternal health disparities. If efficacious, Centering HER may be a low cost, sustainable, translatable option ot prevent preeclampsia in at-risk populations.

项目总结/摘要：项目5（SMITH） 背景：美国是发达国家中孕产妇死亡率最高的国家， 美国的孕产妇死亡是可以预防的。先兆子痫，一种妊娠期疾病， 高血压和蛋白尿是孕产妇死亡的首要可预防原因，也是健康的重要驱动因素 慢性高血压是先兆子痫的主要危险因素，据估计， 3%至5%的怀孕，但在黑人妇女中的患病率要高出60%。黑人女性携带3到4倍的 与白人相比，死于先兆子痫的风险更大。研究表明，高风险的女性 先兆子痫患者接受81至150毫克的阿司匹林和咨询，并自我监测他们的高血压 怀孕11-16周直到36周。典型的产前检查时间较短（平均10分钟） 阻碍了提供者提供基于证据的先兆子痫教育和咨询的能力。到目前为止， 此外，目前的研究并没有利用产前检查的创新和循证模型， 护理和高血压控制，已被证明是可行的供应商和病人。因此，有一个关键的 需要以可持续的模式实施和提供符合指南的先兆子痫预防， 消除了照顾处于危险中的黑人妇女的障碍。研究设计：本项目的长期目标是减少 通过增加获得机会， 以证据为基础的护理。本研究的目的是完善和试点测试一种新的干预措施， 旨在解决患者和提供者预防先兆子痫的障碍。干预，集中她 （健康、赋权和生殖），结合了完善和有效的团体产前护理 模式-以妊娠为中心-以一个有前途的远程医疗为基础的高血压控制计划-采取 控制你的血压。为达致研究目的，本研究提出以下具体目标： 收集最终使用者对集中式医疗卫生服务的可行性和可接受性的意见，2）试行经修订的集中式医疗卫生服务 HER并收集可行性和中间结果数据，以及3）确定定心的有效性 HER改善血压监测、阿司匹林依从性和实施措施。潜在 影响：目标的成功完成对于解决先兆子痫的基石非常重要 预防-产前护理、坚持服药和血压监测，减少孕产妇健康 差距。如果有效，集中HER可能是一种低成本，可持续，可转化的预防选择 先兆子痫的危险人群。