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

在区域化围产期卫生系统中实施孕产妇复苏课程：最大化生存链以减少孕产妇健康不平等

• 批准号: 10831699
• 负责人: Shayna Cunningham
• 金额: $ 48.49万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10831699
• 关键词: Implementation; Maternal; Resuscitation; Curriculum; Regionalized

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.

项目摘要/摘要 在美国，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是可以预防的，但地理差异仍然存在，只要及时和适当 关心。大多数医疗急救员在护理经历了母体疾病的患者方面并不是最熟练的 医疗紧急情况，包括产妇心脏骤停。这一差距存在于急救人员之间和 医疗专科，甚至是接受过高级心血管生命支持培训的产科专家。先导 妇女保健和复苏组织都呼吁努力更好地准备医疗保健 产妇急救工作人员(HCW)，以及越来越多的联邦机构和州立法机构 正在鼓励或要求医院提供这种教育和培训。尽管如此，实施 在美国各地的卫生系统中针对孕产妇紧急医疗事件的循证教育是 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)，第一个在整个链条上培训卫生工作者的跨学科模拟课程 生存的关键在于预防、识别和管理孕产妇医疗紧急情况。来自美国的初步数据 随机交叉试验显示临床能力、知识和 与对照组相比，干预组的自信心更强。然而，由于这次经过验证的模拟训练是 仅在目前才可供提供者和医疗保健组织使用，传播和 目前尚不存在实施最佳做法。本项目的目标是评估培训培训者 在整个亚利桑那州的各种医院和院前环境中实施OBLSTM的方法。这个 这项研究将与亚利桑那州围产期信托基金合作进行，该信托基金是最古老的区域化围产期 美国的医疗保健系统和亚利桑那州的紧急医疗服务。由以下人士组成的督导委员会 地方、地区和国家利益攸关方将为所有研究活动提供指导和监督。 具体地说，这项研究的目的是：(1)从亚利桑那州的医院和院前环境中识别和培训卫生工作者，以 成为OBLSTM指导员，优先为产妇保健沙漠和其他边缘化社区服务 面临不良孕产妇健康后果的风险；(2)在医院和院前实施OBLSTM 在全州范围内，培训由当地教师领导；以及(3)评估OBLSTM的实施情况，并 过程结果。研究设计需要一种混合方法方法，由合并的 实施研究框架和RE-AIM框架。为了促进快速学习，我们将 进行两个连续的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和经验教训。研究的严谨务实 方法将导致迅速和相关的发现，将被用于促进国家扩大这一 重要的医疗创新。