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Minding the gap: a multidisciplinary approach to reducing maternal health disparities in Georgia

关注差距：减少格鲁吉亚孕产妇健康差异的多学科方法

基本信息

批准号：
10640856
负责人：
ESTHER KATHLEEN ADAMS
金额：
$ 72.13万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-14 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10640856
关键词：
Adherence Admission activity Affect Birth Caring Case Management Case Manager Cessation of life Chronic Clinical Collaborations Communities Complex Computerized Medical Record Contraceptive methods Data Developed Countries Diabetes Mellitus Disparity Enrollment Ethnic Origin Ethnic Population Evaluation Familiarity Family Planning Family Planning Programs Foundations Future Gestational Diabetes Guidelines Health Health Care Visit Health Personnel Health Services Health system Healthcare Healthcare Systems Hospitalization Hospitals Hypertension Improve Access Individual Institution Insurance Intervention Interview Knowledge Link Live Birth Location Low income Managed Care Maternal Health Maternal Mortality Medicaid Medical Methods Mind Minority Women Mothers National Institute on Minority Health and Health Disparities Not Hispanic or Latino Obesity Outcome Outcome Assessment Outcome Measure Participant Pharmaceutical Preparations Policies Politics Postpartum Period Postpartum Women Pregnancy Pregnancy Complications Pregnant Women Prenatal care Prevalence Prevention strategy Primary Care Process Measure Provider Race Randomized Recommendation Records Research Resources Review Committee Risk Risk Factors Services Site Social support System Time Translating Uninsured Variant Very Low Birth Weight Infant Visit Woman Work adverse outcome cardiometabolism cardiovascular risk factor care fragmentation care outcomes care systems design disparities in morbidity disparity reduction ethnic difference ethnic disparity experience follow-up health care service utilization health disparity high risk hospital readmission improved inner city insight interdisciplinary approach maternal morbidity multidisciplinary outreach patient oriented postpartum care pragmatic randomized trial pregnancy hypertension prenatal preventable death programs racial difference racial disparity racial population randomized trial safety net screening severe maternal morbidity social standard care standard of care success systematic review

项目摘要

PROJECT SUMMARY The US maternal mortality ratio (26.4 maternal deaths per 100,000 livebirths) is the highest among developed nations, with wide variation across states and racial/ethnic groups. The state of Georgia has the second highest maternal mortality (66.3 per 100,000), with a 60% higher rate for black vs white women (95.6 vs 59.7 per 100,000). Nearly 100 times more common than maternal mortality, however, is severe maternal morbidity (SMM). Maternal mortality and SMM are highest among women who are black, publicly insured or uninsured, and deliver in safety-net hospitals. In Georgia, nearly two-thirds of maternal deaths and SMM are deemed preventable, with chronic health conditions, obesity, delays in accessing and fragmentation of care as key contributors. Current data indicate that postpartum SMM is increasing at a faster rate than SMM during the delivery hospitalization. Proposed solutions to the maternal health crisis in Georgia include improved prenatal and postpartum follow-up and case management, control of chronic health conditions, and extension of Medicaid coverage. However, there is a dearth of evidence regarding whether such strategies can improve maternal health or reduce racial disparities in SMM or mortality. The proposed study will begin to fill this void with a multidisciplinary, mixed-methods approach. We will first analyze Georgia linked vital records, hospital discharge, and claims data to provide an overview of the extent, location and determinants of differences in SMM among non-Hispanic black and non-Hispanic white women at delivery and 3 to 12 months postpartum. Using regression-based decomposition methods we will highlight the portions of the racial/ethnic differences explained by observable and unobservable factors. We will use these findings and in-depth interviews with postpartum women and their health care providers and case managers to contextualize the analysis of two postpartum interventions targeting women at risk for adverse outcomes – an existing Medicaid policy and a newly designed health system intervention. The Georgia Medicaid Planning for Healthy Babies (P4HB) Medicaid program provides postpartum women with a very low birth weight delivery primary care inclusive of nurse case management and Resource Mother outreach to link women to social supports. This study will be the first to evaluate the effects of this Medicaid policy on SMM disparities. These analyses will then be used to inform the design of the new postpartum care system for women who deliver at a safety-net hospital in Atlanta, Georgia, and are at increased risk for SMM. Women (N = 320) will be randomly assigned to either this enhanced postpartum care system vs. standard care, with assessment of outcomes within 12 weeks and 12 months postpartum, including attendance of postpartum care visits, receipt of recommended care, and adverse outcomes such as hospital readmissions. The insights gained from the proposed work will fill critical knowledge gaps regarding policy and practice approaches for reducing maternal health disparities and can serve as a foundation for future prevention and intervention strategies within the state and nationally.

项目摘要美国的孕产妇死亡率（每10万例活产中有26.4例孕产妇死亡）是发达国家中最高的。国家之间和种族/族裔群体之间的差异很大。格鲁吉亚州拥有第二个产妇死亡率最高（每10万人中有66.3人死亡），黑人妇女的死亡率比白色妇女高60%（95.6比59.7 每100，000人）。然而，严重的孕产妇发病率几乎是孕产妇死亡率的100倍（SMM）。黑人妇女、有公共保险或没有保险的妇女的孕产妇死亡率和最低保证医疗率最高，在安全网医院分娩在格鲁吉亚，近三分之二的孕产妇死亡和SMM被认为是可预防，慢性健康状况、肥胖、延迟获得护理和护理分散是关键贡献者。目前的数据表明，产后SMM的增长速度比产后SMM快。分娩住院。解决格鲁吉亚孕产妇健康危机的建议包括改善产前保健，产后跟踪和病例管理，控制慢性健康状况，医疗保险。然而，缺乏证据表明这些策略是否可以改善产妇保健或减少SMM或死亡率方面的种族差异。拟议的研究将开始填补这一空白采用多学科、混合方法。我们将首先分析与格鲁吉亚相关的生命记录，索赔数据，以提供一个概述的程度，地点和决定因素的差异，非西班牙裔黑人和非西班牙裔白色妇女分娩时和产后3至12个月的SMM。使用基于回归的分解方法，我们将突出种族/民族差异的部分用可观察和不可观察的因素来解释。我们将利用这些发现和深入采访，产后妇女和他们的医疗保健提供者和个案管理人员的背景下分析两个针对有不良结局风险的妇女的产后干预措施-现有的医疗补助政策和新设计的卫生系统干预措施。格鲁吉亚健康婴儿医疗补助计划（P4 HB）医疗补助计划为产后妇女提供极低出生体重分娩初级保健，包括护士个案管理和“资源母亲”外联活动，将妇女与社会支助联系起来。本研究将第一次评估医疗补助政策对SMM差异的影响。这些分析将用于为在亚特兰大一家安全网医院分娩的妇女设计新的产后护理系统，格鲁吉亚，并在SMM的风险增加。女性（N = 320）将被随机分配至加强产后护理系统与标准护理相比，在12周内和12周内评估结果产后数月，包括产后护理访视的出席率，接受推荐的护理，以及不良反应结果如再入院。从拟议的工作中获得的见解将填补关键知识在减少孕产妇健康差距的政策和实践方法方面存在差距，为今后在州内和全国范围内的预防和干预战略奠定基础。