Implementation of a Maternal Resuscitation Curriculum in a Regionalized Perinatal Health System: Maximizing the Chain of Survival to Reduce Maternal Health Inequities

项目总结/摘要 在美国，孕产妇发病率和死亡率正在上升，极端的种族和 尽管这些结果在很大程度上可以通过及时和适当的预防措施来预防， 在乎大多数医疗急救人员在照顾经历孕产妇死亡的患者方面并不精通 医疗紧急情况，包括产妇心脏骤停。这种差距存在于第一反应者和跨 医学专业，甚至是接受过高级心血管生命支持培训的产科专家。领导 妇女保健和复苏方面的组织都呼吁努力更好地准备保健， 产妇医疗紧急情况工作人员（HCW），越来越多的联邦机构和州立法机构 鼓励或要求医院提供这种教育和培训。然而，执行 在美国各地的卫生系统中， 不存在不一致的国家认证标准。研究小组开发了产科生活 SupportTM（OBLSTM）是首个跨学科的模拟课程，用于培训整个供应链的HCW 预防、识别和管理孕产妇医疗紧急情况。的初步数据 随机、交叉试验显示临床能力、知识和 与对照组相比，干预组的信心。然而，由于这种经过验证的模拟训练是 提供者和医疗保健组织现在才能获得和访问，传播和 目前尚不存在执行方面的最佳做法。本项目的目的是评估一个培训员培训方案 在亚利桑那州的各种医院和院前环境中实施OBLSTM的方法。的 这项研究将与亚利桑那州围产期信托基金会合作进行，亚利桑那州围产期信托基金会是最古老的区域化围产期信托基金会。 美国亚利桑那州紧急医疗服务中心（Arizona Emergency Medical Services）指导委员会，由 地方、区域和国家利益相关者将为所有研究活动提供指导和监督。 具体来说，这项研究的目的是：（1）确定和培训卫生保健员从医院和院前环境在亚利桑那州， 成为OBLSTM教师，优先考虑那些为产妇护理沙漠和其他边缘化社区服务的教师 在医院和院前环境中实施OBLSTM 在全州范围内，培训由当地教师领导;（3）评估OBLSTM的实施情况， 过程结果。研究设计需要采用混合方法，由综合 实施研究框架和RE-AIM框架。为了促进快速学习，我们将 进行两个背靠背的OBLSTM讲师培训，实施和评估周期， 第二个周期将考虑到第一个周期的反馈意见和经验教训。这项研究严谨务实， 这一方法将产生迅速和相关的结果，用于促进国家扩大这一工作。 重要的医疗创新。

PROJECT SUMMARY/ABSTRACT Maternal morbidity and mortality rates are increasing in the United States (US), and extreme racial and geographic disparities persist, despite these outcomes being largely preventable with timely and appropriate care. Most medical responders are not optimally proficient in caring for patients who experience maternal medical emergencies, including maternal cardiac arrest. This gap exists among first responders and across medical specialties, and even for OB-specialists trained in Advanced Cardiovascular Life Support. Leading organizations in women’s health care and resuscitation have all called for efforts to better prepare healthcare workers (HCWs) for maternal medical emergencies, and increasingly federal agencies and state legislatures are incentivizing or requiring hospitals to provide this education and training. Nonetheless, the implementation of evidence-based education for maternal medical emergencies in health systems across the US is inconsistent and national credentialing standards do not exist. The study team developed Obstetric Life SupportTM (OBLSTM), the first of its kind interdisciplinary simulation curriculum to train HCWs across the chain of survival on preventing, recognizing, and managing maternal medical emergencies. Preliminary data from a randomized, cross-over trial shows significant improvement in clinical competencies, knowledge, and confidence for the intervention group compared to the control. However, as this validated simulation training is only just now available and accessible to providers and healthcare organizations, dissemination and implementation best practices do not yet exist. The objective of this project is to evaluate a train-the-trainer approach for implementing OBLSTM in a diversity of hospital and prehospital contexts throughout Arizona. The study will be conducted in partnership with the Arizona Perinatal Trust, the oldest regionalized perinatal healthcare system in the US, and Arizona Emergency Medical Services. A Steering Committee composed of local, regional, and national stakeholders will provide guidance and oversight for all study activities. Specifically, the study aims to: (1) Identify and train HCWs from hospital and prehospital contexts in Arizona to be OBLSTM instructors, prioritizing those that serve maternity care deserts and other marginalized communities at risk of adverse maternal health outcomes; (2) Implement OBLSTM in hospital and prehospital contexts across the state, with the training being led by local instructors; and (3) Evaluate OBLSTM implementation and process outcomes. The study design entails a mixed methods approach, informed by the Consolidated Framework for Implementation Research and the RE-AIM framework. To promote rapid learning, we will conduct two back-to-back OBLSTM instructor training, implementation, and evaluation cycles, whereby the second cycle will take into account feedback and lessons learned from the first. The study’s rigorous pragmatic approach will result in expeditious and relevant findings that will be used to promote national scale-up of this important health care innovation.