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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

基本信息

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
项目类别：
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&apos 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

项目摘要

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.

抽象的美国严重孕产妇发病率和死亡率方面持续存在且不断恶化的种族和民族差异紧迫的公共卫生问题需要创新、可持续的解决方案。围产期、产前的时间产后，对妇女及其孩子的健康具有重要影响。不幸的是，标准围产期护理未能满足黑人、原住民和有色人种妇女 (BIPOC) 的需求社区，特别是考虑到健康的社会决定因素 (SDoH) 和系统性种族主义导致健康差异。越来越多的人建议使用导乐护理来支持高危 BIPOC 女性分娩和产后初期，旨在减轻种族歧视和 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只能从事工作与医疗团队并行，其潜在后果包括护理协调脱节并错过了提高 BIPOC 女性医疗保健质量的机会。以我们团队之前和当前的工作是优化医疗服务不足的妇女的围产期护理，我们将开发和评估良好的妈妈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干预，这些中心已美国一些孕产妇发病率和死亡率最高的国家。 Well-Mama 干预的重点是社区导乐支持的未参保和公共参保孕妇和产后 BIPOC 妇女导航员 (CDN) 将使用 Well-Mama 安全系统进行现场和远程健康检查清单；签到后转介资源，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；参加选定的患者就诊；并提供劳动力支持。 Well-Mama 清单包括 5 个优先主题领域，代表产妇发病率和需要调整导乐师及其患者的死亡率： (a) 心理健康/抑郁； (b) 心血管症状； (c) 安全（例如家中持枪和亲密伴侣暴力）； (d) 类阿片/药物滥用； (e) 社会支持，自我代理和幸福感。 Well-Mama 提出了一种共享护理模式来提供医疗保健服务重点关注与以患者个体为中心的护理相关的跨专业合作。通过混合动力对 N = 576 名女性进行的 1 类随机有效性实施试验，我们将比较以下方法的有效性 Well-Mama 干预相对于标准围产期护理在改善妇女接受建议方面的效果护理组成部分（主要结果），减少患者的医疗不信任和种族主义/歧视经历，提高健康参与度、自我效能和对护理团队质量的认知，并加强围产期护理团队凝聚力（次要结果），同时评估干预措施的实施情况。结果将优化导乐综合围产期护理，解决孕产妇发病率和死亡率的首要驱动因素，目标是减少 BIPOC 孕妇和产后妇女所经历的孕产妇健康差异。