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.

项目摘要/摘要：项目5(史密斯) 背景：美国的孕产妇死亡率是发达国家中最高的，超过60%的 在美国，孕产妇死亡是可以预防的。先兆子痫，一种妊娠障碍，其特征是 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 美国慢性高血压是先兆子痫的主要危险因素，据估计， 3%到5%的怀孕，但在黑人女性中发病率高出60%。黑人女性携带着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，患高血压的高危女性 先兆子痫接受81至150毫克阿司匹林治疗，并对其高血压进行咨询和自我监测 妊娠11-16周至36周。典型产前检查的短暂持续时间(平均10分钟) 妨碍提供者提供以证据为基础的子痫前期教育和咨询的能力。到目前为止， 此外，目前的研究没有利用创新的和基于证据的产前模式 护理和高血压控制已被证明对提供者和患者是可行的。因此，有一个关键的 需要以可持续的模式实施和提供指南一致的先兆子痫预防 消除了照顾高危黑人妇女的障碍。研究设计：该项目的长期目标是减少 通过增加机会增加黑人孕妇中不必要的先兆子痫和先兆子痫相关死亡 以证据为基础的护理。这项研究的目的是提炼和试行一种新的干预措施，即 旨在解决患者和提供者在预防先兆子痫方面的障碍。干预，以她为中心 (健康、赋权和生殖)，结合了一组完善和有效的产前护理 以怀孕为中心的模型-有前景的基于远程医疗的高血压控制计划-Take 控制你的血压。为了达到我们的研究目标，研究提出了以下具体目标：1) 为获得最终用户对居中的可行性和可接受性的意见，2)试行修订后的居中 HER并收集可行性和中期结果数据，以及3)确定居中的有效性 她提出了改善血压监测、阿司匹林依从性等实施措施。潜力 影响：成功完成目标对于解决先兆子痫的基石将是重要的 预防--产前护理、服药依从性和血压监测，降低产妇健康 差距。如果有效，以她为中心可能是一个低成本、可持续、可翻译的预防选择 高危人群中的先兆子痫。