The Impacts of State Quality Care Collaboratives on Maternal Health Disparities by Race/Ethnicity

州质量护理合作机构对不同种族/族裔孕产妇健康差异的影响

• 批准号: 10522222
• 负责人: Evan David Peet
• 金额: $ 68.4万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-29 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10522222
• 关键词: Address; Adoption; Affect; Birth; Black race; Caring; Cause of Death; Cesarean section; Characteristics; Collaborations; Country; Data; Data Set; Data Sources; Databases; Diagnosis; Economic Conditions; Ethnic Origin; Ethnic group; Foundations; Geography; Health; Health Personnel; Healthcare; Hispanic; Hospitals; Income; Infrastructure; Inpatients; Institutional Racism; Location; Maternal Health; Maternal Mortality; Methods; Network-based; Not Hispanic or Latino; Nulliparity; Outcome; Persons; Placebos; Policies; Population; Pregnancy; Procedures; Process; Public Health; Quality of Care; Race; Research; Resources; Shapes; Social Conditions; Structure; Surveys; Testing; Training; Vital Statistics; Woman; Work; black women; collaborative care; compare effectiveness; design; disparity reduction; ethnic disparity; ethnic diversity; evidence base; experience; falls; implicit bias; improved; insight; novel; operation; people of color; racial and ethnic; racial and ethnic disparities; racial disparity; severe maternal morbidity; social health determinants; trend

PROJECT SUMMARY Compared to many other high-income countries, the U.S. has stark maternal health outcomes – both severe maternal morbidity (SMM) and maternal mortality (MM) have tripled in the U.S. since 1993. Overall, experts estimate that nearly half of SMM and MM is preventable. Black and Hispanic women have borne the brunt of this maternal health crisis with much higher rates of severe maternal mortality (SMM) and maternal mortality (MM) than White women. To address the growing crisis, states increasingly use quality care collaboratives (QCCs) that aim to train healthcare providers using quality improvement (QI) toolkits. These QI toolkits outline maternal care processes designed to improve the diagnosis and treatment of maternal health conditions with the overall aim of reducing SMM and MM. This project will provide the first detailed analysis of the influence of state QCCs and their QI toolkits on maternal care and health outcomes overall, and across racial/ethnic groups. The limited data evaluating a few states’ QCCs indicate that certain QCCs and certain QI toolkits may improve maternal health overall – but even then, racial/ethnic disparities can persist. To assess the impacts of QCCs on maternal care and health, particularly among Black and Hispanic women, we will (1) conduct a first-of-its-kind survey of state public health departments, QCCs, and QCC collaborating hospitals, (2) construct a national state-level database combining the survey data with key maternal care and health outcomes and other publicly available data for 2003 to 2023. With this novel data, we will estimate the effects of QCCs and their QI toolkits, particularly how their effects vary by maternal race/ethnicity. These results will identify which QCCs and QI toolkits are most effective, particularly in addressing racial/ethnic disparities in maternal health. Specifically, we will use the combined data to assess four research questions: (Aim 1) How do trends in maternal care processes and health outcomes vary by race/ethnicity, geography, and other characteristics? (Aim 2) How do QCCs differ? (Aim 3) Do QCCs and their QI toolkits influence maternal care processes and health outcomes? And, (Aim 4) Which QCCs and QI toolkits most effectively address disparities in maternal care processes and health outcomes? We will test the hypotheses that: (H1) generally, QCCs and QI toolkits improve maternal care processes and health outcomes; (H2) the QCCs and QI toolkits that are most effective in reducing racial/ethnic disparities are those that use QI toolkits that focus on key drivers of disparities (e.g. pre-existing health and social conditions); and/or (H3) the QCCs and QI toolkits that are most effective in reducing racial/ethnic disparities are those that collaborate with hospitals serving greater proportions of the states’ Black and Hispanic women. In so doing, our proposed study lays a strong foundation for a comprehensive research agenda on the effects of QCCs on race/ethnic disparities in maternal health which can accelerate improvements in SMM and MM, particularly among Black and Hispanic women who are disproportionately affected but may not benefit equally from QCCs.

项目摘要 与许多其他高收入国家相比，美国的孕产妇健康状况十分严峻， 自1993年以来，美国的孕产妇发病率（SMM）和孕产妇死亡率（MM）增加了两倍。总体而言，专家 估计近一半的SMM和MM是可以预防的。黑人和西班牙裔妇女首当其冲 严重孕产妇死亡率（SMM）和孕产妇死亡率（SMM） 死亡率（MM）高于白色女性。为了解决日益严重的危机，各州越来越多地使用优质护理 协作组织（QCC）旨在使用质量改进（QI）工具包培训医疗保健提供者。这些炼气 工具包概述了产妇护理流程，旨在改善产妇健康的诊断和治疗 条件，总体目标是减少SMM和MM。该项目将提供第一个详细分析 国家质量控制委员会及其质量信息工具包对孕产妇护理和健康结果的影响，以及 种族/民族群体。有限的数据评估几个国家的质量控制中心表明，某些质量控制中心和 某些QI工具包可能会改善产妇的整体健康-但即使这样，种族/民族差异可能会持续存在。到 评估QCC对孕产妇保健和健康的影响，特别是在黑人和西班牙裔妇女中，我们 将（1）对州公共卫生部门、质量控制委员会和质量控制委员会进行首次调查 （2）建立国家级数据库，将调查数据与关键字相结合， 2003年至2023年孕产妇保健和健康成果以及其他公开数据。有了这些新数据， 我们将评估QCC及其QI工具包的影响，特别是它们的影响如何随孕产妇的不同而变化。 种族/民族。这些结果将确定哪些QCC和QI工具包是最有效的，特别是在解决 产妇保健方面的种族/民族差异。具体而言，我们将使用合并数据评估四项研究 问题：（目标1）产妇护理过程和健康结果的趋势如何因种族/族裔而异， 地理和其他特征？(Aim 2）QCC有何不同？(Aim 3）QCC及其QI工具包 影响产妇护理过程和健康结果？以及，（目标4）哪些QCC和QI工具包 有效解决孕产妇保健过程和保健成果方面的差距？我们将检验 （H1）一般而言，质量控制中心和质量保证工具包可改善孕产妇护理流程和健康结果;（H2） 在减少种族/民族差异方面最有效的QCC和QI工具包是那些使用 侧重于差异的主要驱动因素（例如预先存在的健康和社会条件）的QI工具包;和/或 (H3)在减少种族/民族差异方面最有效的QCC和QI工具包是那些 与医院合作，为更多的黑人和西班牙裔妇女提供服务。这样 这样做，我们提出的研究奠定了坚实的基础，全面的研究议程的影响，质量控制中心 产妇保健方面的种族/族裔差异，这可以加速SMM和MM的改善， 在黑人和西班牙裔妇女中，她们受到不成比例的影响，但可能无法从QCC中平等受益。