Enhancing Perinatal Care Support to Improve Maternal Mortality Disparities

加强围产期护理支持以改善孕产妇死亡率差异

• 批准号: 10630873
• 负责人: MELISSA A. SIMON
• 金额: $ 57.99万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-24 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10630873
• 关键词: Address; American College of Obstetricians and Gynecologists; Area; Birth; Black, Indigenous, People of Color; Cardiovascular system; Caring; Chicago; Child; Collaborations; Communities; Community Health Aides; Developed Countries; Discipline of obstetrics; Discrimination; Disparity; Emergency Situation; Emotional; Ethnic Origin; Failure; Feedback; Fostering; Goals; Guidelines; Guns; Health; Healthcare Systems; High-Risk Pregnancy; Home; Hospitals; Hybrids; Institutional Racism; Intervention; Knowledge; Lead; Maternal Health; Maternal Mortality; Medical; Medical Care Team; Medical center; Mental Depression; Mental Health; Modeling; Opioid; Outcome; Patient Care; Patient Selection; Patients; Perception; Perinatal Care; Personal Satisfaction; Persons; Postpartum Period; Postpartum Women; Practical Robust Implementation and Sustainability Model; Pregnancy; Pregnancy Complications; Pregnant Women; Prenatal care; Public Health; Qualitative Methods; Quality of Care; Race; Recommendation; Resources; Role; Safety; Self Efficacy; Service delivery model; Site; Social support; Substance abuse problem; Support Groups; Symptoms; Testing; Time; Underserved Population; Uninsured; Variant; Visit; Woman; Women' s Health; Work; black women; care coordination; cohesion; compare effectiveness; distrust; effectiveness-implementation randomized trial; ethnic disparity; experience; group intervention; health care availability; health care delivery; health care quality; health disparity; high risk; implementation evaluation; implementation intervention; improved; individual patient; innovation; intervention effect; intimate partner violence; low and middle-income countries; maternal morbidity; maternal outcome; medically underserved; mortality disparity; patient navigator; perinatal period; postpartum care; pregnant; primary outcome; racial disparity; racism; randomized trial; secondary outcome; severe maternal morbidity; skills; social health determinants; standard care; telehealth; uptake; virtual; women of color

ABSTRACT Persistent and worsening racial and ethnic disparities in severe maternal morbidity and mortality in the US are urgent public health concerns requiring innovative, sustainable solutions. The perinatal period, the time before and after birth, has important implications for a woman’s health and that of her child. Unfortunately, standard perinatal care fails to meet the needs of women from Black, Indigenous and People of Color (BIPOC) communities, especially with consideration to the Social Determinants of Health (SDoH) and the systemic racism that drive health disparities. Doula care is increasingly recommended to support high-risk BIPOC women during labor and the immediate postpartum period and is posited to mitigate the effects of racism and SDoH in underserved populations. However, a key limitation to doula care is that doulas are largely relegated to working in parallel with the healthcare team and the potential consequences of this include disjointed care coordination and missed opportunities to improve healthcare quality for BIPOC women. Building on our team’s prior and current work optimizing perinatal care for medically underserved women, we will develop and evaluate a Well- Mama intervention in 3 participating medical centers in Chicago IL, Baton Rouge LA, and Newark NJ which have some of the highest US rates of maternal morbidity and mortality. The Well-Mama intervention is centered on uninsured and publicly insured pregnant and postpartum BIPOC women supported by Community Doula Navigators (CDNs) who will conduct in-person and telehealth wellness check-ins using the Well-Mama safety checklist; make referrals to resources following the check-ins, with feedback provided to the perinatal care team; lead virtual pregnancy and postpartum support groups; attend select patient visits; and provide labor support. The Well-Mama checklist includes 5 priority topic areas representing leading factors in maternal morbidity and mortality in which to attune doulas and their patients: (a) mental health/depression; (b) cardiovascular symptoms; (c) safety (e.g., guns at home and intimate partner violence); (d) opioid/substance abuse; and (e) social support, self-agency, and well-being. Well-Mama advances a Shared Care Model approach to health care delivery focused on interprofessional collaboration in relation to centering care on the individual patient. Through a Hybrid Type 1 randomized effectiveness-implementation trial of N=576 women, we will compare the effectiveness of the Well-Mama intervention relative to standard perinatal care in improving women’s receipt of recommended care components (primary outcome), reducing patient medical distrust and experience of racism/discrimination, increasing health engagement, self-efficacy, and perception of care team quality, and enhancing perinatal care team cohesion (secondary outcomes), while evaluating intervention implementation. Results will optimize doula integrated perinatal care to address the top drivers of maternal morbidity and mortality with the goal of reducing maternal health disparities experienced by pregnant and postpartum BIPOC women.

摘要 美国严重孕产妇发病率和死亡率的种族和民族差异持续恶化， 迫切的公共卫生问题需要创新的、可持续的解决方案。围产期， 以及出生后，对妇女及其子女的健康有着重要的影响。不幸的是，标准 围产期护理未能满足黑人、土著和有色人种妇女的需求（BIPOC） 社区，特别是考虑到健康的社会决定因素（SDoH）和系统性的种族主义 导致了健康差距。越来越多的人建议使用导乐护理来支持高危BIPOC女性 劳动和产后立即期，并假定以减轻种族主义和SDoH的影响， 服务不足的人群。然而，导乐护理的一个关键限制是，导乐在很大程度上被降级为工作 与医疗团队并行，其潜在后果包括脱节的护理协调 错过了改善BIPOC妇女医疗保健质量的机会。根据我们团队的先前经验 目前的工作优化围产期保健的医疗服务不足的妇女，我们将制定和评估一个良好的， 在伊利诺伊州芝加哥、洛杉矶巴吞鲁日和新泽西州纽瓦克的3个参与医疗中心进行了妈妈干预， 美国产妇发病率和死亡率最高的地区之一。健康妈妈的干预集中在 在社区导乐陪伴下的未投保和公共投保的BIPOC孕妇和产后妇女 导航员（CDN），他们将使用Well-Mama安全系统进行现场和远程健康检查 检查表;在检查后向资源转介，并向围产期护理团队提供反馈; 领导虚拟怀孕和产后支持小组;参加选定的病人访问;并提供劳动支持。 健康妈妈清单包括5个优先主题领域，代表孕产妇发病率的主要因素， 死亡率，其中调和导乐和他们的病人：（a）心理健康/抑郁症;（B）心血管症状; (c)安全性（例如，家庭枪支和亲密伴侣暴力）;（d）阿片类药物/药物滥用;（e）社会支助， 自我能动性和幸福感Well-Mama推进了共享护理模式的医疗保健提供方法 专注于跨专业合作，以患者为中心进行护理。通过混合 在N=576名女性中进行的1型随机有效性-实施试验，我们将比较 与标准围产期护理相关的“健康妈妈”干预措施在改善妇女接受建议的 护理组成部分（主要结局），减少患者对医疗的不信任和种族主义/歧视的经历， 提高健康参与度、自我效能和对护理团队质量的认识，并加强围产期护理 团队凝聚力（次要成果），同时评价干预措施的实施情况。结果将优化导乐 综合围产期护理，以解决孕产妇发病率和死亡率的主要驱动因素， BIPOC妇女怀孕和产后经历的孕产妇健康差异。