"Maternal Outcome Monitoring and Support (MOMS) - A mHealth symptom self-monitoring and decision support system to reduce racial and ethnic disparities in postpartum outcomes

项目摘要/摘要 在过去的二十年里，美国的严重孕产妇发病率上升了120-200%。 专家估计，其中40%-60%的病例是可以预防的。2、3与产后自杀或自残有关 精神问题虽然通常与SMM分开报告，但仍是产妇的第二大原因 死亡。4，5其他未导致死亡的重症急性精神病事件(IAPE) SMM的统计。改善倡议主要是以医院为基础的，并依赖于妇女认识到 在没有足够的支持或教育的情况下，他们自己的症状和寻求治疗。我们假设我们可以 通过帮助患者进行自我监控来提高患者的自我效能感和对何时寻求治疗的决策 症状和提供决策支持。我们建议开发一种基于mHealth的、患者报告的 结果(PRO)和决策支持系统，帮助母亲确定何时寻求对警告迹象的护理 SMM的。我们的项目重点关注面临产后差异的不同人群，特别是非洲人- 说美语和西班牙语的拉丁裔女性。长期目标是使本达博士能够利用这一点 致力于独立的研究计划，该计划将设计、评估和实施技术以 提高健康公平。利用威尔康奈尔医学院的强大资源和外部顾问，工作 在K99阶段，将开发和验证产后症状设计要求的框架 报告和决策支持需求。在R00阶段，本达博士将独立设计、评估和 试行mHealth PRO和决策支持工具，以提高产后患者的知识和自我效能 在SMM和IAPE领域。具体目标是：1)开发和完善设计框架 产后症状报告和决策支持需求的要求；2)设计和评估 通过与专家的启发式反馈与患者进行可用性测试的MOMS/MAMA功能原型； 和3)进行试点试验，评估MOMS/MAMA的可行性和初步效果 提高产后SMM高危患者的知识和自我效能。为了实现这些目标， 我们已经组建了一支跨学科的团队，拥有信息学、护理、公共卫生、 少数民族健康、临床试验和技术设计与评估。我们的团队也有临床领域 在产科/妇科和心理学/精神病学方面的专业知识。我们的提案涉及重要的公共卫生问题 (SMM和IAPE)，并试图通过以受影响最大的少数群体为目标来缩小差距。 鉴于一系列新的能力和以患者为中心的多学科性质的工作，这 K99/R00奖是实现候选人以技术为基础的设计职业目标的必要步骤 促进卫生公平的干预措施。

PROJECT ABSTRACT/SUMMARY Severe maternal morbidity (SMM) rates have risen 120-200% in the United States in the past two decades,1 and experts estimate that 40-60% of these cases are preventable.2,3 Suicide or self-harm related to postpartum psychiatric issues, although typically reported separately from SMM, is the second leading cause of maternal death.4,5 There additional intensive-acute psychiatric events (IAPE) that do not result in death not reflected in statistics of SMM. Improvement initiatives are predominantly hospital-based and rely on women recognizing their own symptoms and seeking care without ample support or education. We hypothesize that we can improve patients’ self-efficacy and decision-making about when to seek care by helping them to self-monitor symptoms and by providing decision support. We propose to develop a mHealth-based, patient-reported outcome (PRO) and decision-support system to help mothers determine when to seek care for warning signs of SMM. Our project focuses on diverse populations facing postpartum disparities, particularly African- American and Spanish-speaking Latina women. The long-term goal is to enable Dr. Benda to leverage this work into an independent research program, which will design, evaluate, and implement technologies to improve health equity. Using the robust resources of Weill Cornell Medical College and external advisors, work in the K99 phase will develop and validate a framework of design requirements for postpartum symptom reporting and decision-support needs. In the R00 phase, Dr. Benda will independently design, evaluate, and pilot a mHealth PRO and decision-support tool to improve knowledge and self-efficacy for postpartum patients in the areas of SMM and IAPE. The specific aims are to: 1) develop and refine a framework of design requirements for postpartum symptom reporting and decision-support needs; 2) design and evaluate a functioning prototype of MOMS/MAMA through heuristic feedback with experts usability testing with patients; and 3) conduct a pilot trial assessing the feasibility and preliminary effectiveness of MOMS/MAMA for improving knowledge and self-efficacy among postpartum patients at risk of SMM. To accomplish these aims, we have assembled an interdisciplinary team with research expertise in informatics, nursing, public health, minority health, clinical trials, and technology design and evaluation. Our team also has clinical domain expertise in obstetrics/gynecology and psychology/psychiatry. Our proposal addresses important public health issues (SMM and IAPE) and seeks to reduce disparities by targeting minority groups most affected by them. Given the array of new competencies and the multidisciplinary nature of the patient-centered work, this K99/R00 award is a necessary step to achieve the candidate’s career goal of designing technology-based interventions to advance health equity.