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

“孕产妇结局监测和支持 (MOMS) - 移动医疗症状自我监测和决策支持系统，可减少产后结局中的种族和民族差异

• 批准号: 10402792
• 负责人: Natalie Christine Benda
• 金额: $ 9.92万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-07 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10402792
• 关键词: Acute; Address; Affect; African American; African American population; Area; Award; Cardiology; Cardiomyopathies; Cardiovascular Diseases; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Nurse Specialists; Clinical Trials; Competence; Decision Making; Decision Support Systems; Discipline of Nursing; Discipline of obstetrics; Education; Effectiveness; Emergency Medicine; Enrollment; Ethnic Origin; Evaluation; Event; Feedback; Goals; Guidelines; Gynecology; Health; Health Services; Hemorrhage; Hospitals; Infection; Informatics; Information Technology; Intervention; Interview; K-Series Research Career Programs; Knowledge; Language; Latina; Latina Population; Limited English Proficiency; Maternal Health; Maternal Mortality; Measures; Medical; Mental Depression; Mentors; Minority Groups; Monitor; Mothers; National Institute on Minority Health and Health Disparities; Nature; Obstetrical Nursing; Oncology; Outcome; Paper; Participant; Patient Outcomes Assessments; Patients; Phase; Population Heterogeneity; Postpartum Depression; Postpartum Period; Postpartum Women; Psychiatry; Psychology; Public Health; Pulmonary Embolism; Questionnaires; Race; Reduce health disparities; Reporting; Research; Research Personnel; Research Support; Resources; Risk; Sampling; Self Efficacy; Self-Injurious Behavior; Sepsis; Signs and Symptoms; Structure; Suicide; Surveys; Symptoms; System; Technology; Testing; Training; Training Support; Underserved Population; United States; Woman; Women' s Health; Work; base; care seeking; career; clinical care; demographics; design; disparity reduction; experience; health application; health disparity; health equity; health information technology; heuristics; improved; information seeking behavior; mHealth; maternal morbidity; medical schools; minority health; multidisciplinary; patient oriented; pilot trial; postpartum outcome; pre-doctoral; primary outcome; programs; prototype; racial and ethnic disparities; recruit; secondary outcome; severe maternal morbidity; statistics; support tools; therapy design; usability; user centered design

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.

项目摘要/总结 过去 20 年来，美国的严重孕产妇发病率 (SMM) 上升了 120-200%1 专家估计，其中 40-60% 的病例是可以预防的。2,3 与产后相关的自杀或自残 精神问题虽然通常与 SMM 分开报告，但却是孕产妇的第二大原因 死亡。4,5 还有其他未导致死亡的重症急性精神事件 (IAPE) 未反映在 SMM统计。改进举措主要以医院为基础，并依赖于妇女的认识 他们自己的症状并在没有足够支持或教育的情况下寻求护理。我们假设我们可以 通过帮助患者进行自我监控，提高患者的自我效能和何时就医的决策 症状并提供决策支持。我们建议开发一种基于移动医疗、患者报告的 结果 (PRO) 和决策支持系统可帮助母亲确定何时因警告信号而寻求护理 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 美国和西班牙语拉丁裔女性。长期目标是让 Benda 博士能够利用这一点 致力于一个独立的研究计划，该计划将设计、评估和实施技术 改善健康公平。利用威尔康奈尔医学院和外部顾问的强大资源，开展工作 K99阶段将开发并验证产后症状的设计要求框架 报告和决策支持需求。在R00阶段，Benda博士将独立设计、评估和 试点 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）设计并评估 MOMS/MAMA 的功能原型，通过专家对患者进行可用性测试的启发式反馈； 3) 进行试点试验，评估 MOMS/MAMA 的可行性和初步有效性 提高有 SMM 风险的产后患者的知识和自我效能。为了实现这些目标， 我们组建了一支跨学科团队，拥有信息学、护理、公共卫生、 少数民族健康、临床试验以及技术设计和评估。我们的团队也有临床领域 产科/妇科和心理学/精神病学专业知识。我们的提案涉及重要的公共卫生问题 问题（SMM 和 IAPE），并寻求通过针对受问题影响最严重的少数群体来减少差距。 鉴于一系列新的能力和以患者为中心的工作的多学科性质，这 K99/R00 奖项是实现候选人以技术为基础的设计职业目标的必要步骤 促进健康公平的干预措施。