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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.

摘要