Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk

在美国，产妇死亡率方面存在着令人震惊的种族和民族差异。黑人女性的年龄是三到四岁 与白人女性相比，在一些地区，死于妊娠相关死亡的可能性要高出一倍 拉丁裔也面临着更高的风险。这种差异根源于黑人和拉丁裔女性经历的事实 在整个妊娠-产后连续过程中，孕产妇健康风险增加。有色人种的女性 可能患有高血压或糖尿病等慢性健康状况而开始怀孕，经历 在怀孕期间出现并发症，并在分娩期间遭受危及生命的发病率。不太为人所知的是 产妇健康风险增加一直延伸到产后时期。黑人和拉丁裔女性更有可能 经历产后并发症，在分娩后到急诊科寻求治疗，以及 与白人女性相比，产后再次住院的风险更高。越来越多的关注已经 将产后期作为解决产妇死亡率差距的一个重要窗口 与怀孕有关的死亡发生在分娩后一天至一年内，大多数产妇死亡 相当大一部分严重并发症是可以预防的。我们提出了一种混合方法研究，以更好地 找出黑人和拉丁裔女性分娩后结局不佳的风险最大，她们的问题 经验，并采用循证干预措施，旨在提高产后护理的质量 高危女性。我们这项研究的目的是“通过有针对性地改善健康结果和公平 产后母亲风险最高“是：1)开发风险预测模型，使用社会人口学， 临床、行为和邻里因素通过急诊和产后检查来确定高危母亲 再次入院作为严重孕产妇发病率的标志。2)用定性的方法适应和强化 旨在提高护理质量的循证行为教育干预措施 通过产后ED使用和再次住院来衡量孕产妇发病率，3)进行RCT试点 利用目标1中的风险预测模型确定的队列来评估可行性、可接受性和目标 精细化干预措施减少急诊室就诊和产后再住院的效果大小和潜在效果 以及4)评估试点研究的结果和程序，以告知干预措施的改进情况，并 为这一干预措施的更大规模实施试验做好准备。

Alarming racial and ethnic disparities in maternal mortality persist in the US. Black women are three to four times more likely to die a pregnancy-related death as compared with White women, and in some regions Latinas are also at increased risk. This disparity is rooted in the fact that Black and Latina women experience elevated maternal health risks throughout the pregnancy-postpartum continuum. Women of color are more likely to begin pregnancy with a chronic health condition such as hypertension or diabetes, experience a complication while pregnant, and to suffer a life-threatening morbidity during delivery. Less recognized is that heightened maternal health risks extend into the postpartum period. Black and Latina women are more likely to experience a postpartum complication, to seek care in the emergency department (ED) after delivery, and have an increased risk of postpartum hospital readmission relative to White women. Growing attention has focused on the postpartum period as an important window to address maternal mortality disparities as half of pregnancy-related deaths occur within one day to one year after delivery and the majority of maternal deaths and a sizable portion severe complications are preventable. We propose a mixed method study to better identify Black and Latina women most at risk for poor outcomes following delivery, the problems they experience, and to adapt an evidence-based intervention that aims to improve quality of postpartum care for high risk women. The aims of our research study, “Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk” are to: 1) Develop a risk a prediction model using sociodemographic, clinical, behavioral, and neighborhood factors to identify high-risk mothers using ED visits and postpartum readmissions as a marker of severe maternal morbidity. 2) Use qualitative methods to adapt and intensify an evidence-based behavioral educational intervention aimed at improving quality of care to reduce severe maternal morbidity as measured by postpartum ED use and hospital readmission, 3) Conduct a pilot RCT utilizing the cohort identified by the risk prediction model in Aim 1 to assess feasibility, acceptability, and target effect size and potential efficacy of the refined intervention to reduce ED visits and postpartum readmissions, and 4) Evaluate the pilot study results and procedures to inform the refinement of the intervention and to prepare for a larger implementation trial of this intervention.