Maternal OutcoMes (MOMs) Program: Testing Integrated Maternal Care Model Approaches to Reduce Disparities in Severe Maternal Morbidity

孕产妇结局 (MOM) 计划：测试综合孕产妇护理模式方法，以减少严重孕产妇发病率的差异

• 批准号: 10835372
• 负责人: Stephanie Lenay Fitzpatrick
• 金额: $ 83.79万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835372
• 关键词: Address; Affect; Behavior; Birth; Black race; Caring; Clinical; Clinical Services; Data; Data Collection; Diagnosis; Discipline of obstetrics; Disparity; Effectiveness; Electronic Health Record; Emotional; Enrollment; Ensure; First Pregnancy Trimester; Fostering; Goals; Health; Health Personnel; Home Blood Pressure Monitoring; Hospitalization; Incidence; Inequity; Intervention; Managed Care; Maternal Health; Maternal Mortality; Measures; Modeling; Monitor; New York; Not Hispanic or Latino; Nurses; Outcome; Participant; Pattern; Persons; Physical activity; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Questionnaires; Randomized; Recording of previous events; Registered nurse; Research Personnel; Risk; Risk Factors; Risk Reduction; Self Management; Services; Social Work; Social support; Surveys; Technology; Telephone; Testing; Time; Touch sensation; United States; Woman; arm; behavioral health; care outcomes; chatbot; comorbidity Index; design; disability; disparities in morbidity; disparity reduction; effectiveness testing; experience; fitbit; health care disparity; high risk; hospital readmission; improved; integrated care; longitudinal design; prenatal; prevent; programs; recruit; severe maternal morbidity; social; two-arm study

PROJECT SUMMARY/ABSTRACT: There is a maternal health crisis in the United States that disproportionately affects Black birthing people. Black birthing people are two times more likely to experience severe maternal morbidity (SMM) - “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a birthing person’s health” – than non-Hispanic White birthing people. Preventing preeclampsia, increased or maintained engagement in healthy behaviors (e.g., physical activity), and support addressing health-related social needs can enhance receipt of timely, appropriate care and reduce risk for SMM. The Maternal OutcoMes (MOMs) Program implemented at Northwell Health is an effective integrated care approach that identifies and supports high-risk birthing people immediately post- delivery. In preliminary analysis based on data from 2500 participants, the MOMs Program significantly reduced risk for SMM-related hospital admissions 30-days post-delivery by 77% among Black participants. These preliminary findings are promising; however, the long-term effectiveness needs to be established as well as the feasibility and effectiveness of extending the MOMs Program to the prenatal period. The purpose of this study is to test the effectiveness of an integrated care model approach at two different levels of intensity designed to facilitate timely, appropriate care for high-risk Black birthing people and reduce risk for SMM. Black birthing people with an Obstetrics-Comorbidity Index Score  3 and/or a history of pre- eclampsia will be identified via the electronic health record and 674 will be recruited and randomized during the first trimester to one of two study arms: MOMs High-Touch (MOMs-HT) vs. MOMs Low-Touch (MOMs- LT). MOMs-HT will consist of close clinical and behavioral health monitoring via chatbot technology and navigation to timely care and services by the MOMs team throughout the prenatal and postpartum periods; 12 bi-weekly self-management support calls with the MOMs team during the prenatal period; and 4 weekly postpartum clinical check-in calls with navigation by the MOMs team immediately post-delivery. MOMs-LT will also include clinical and behavioral health monitoring via the chatbot along with navigation to services by the MOMs team and 4 weekly postpartum clinical check-in calls with navigation. The two study arms will be compared on incidence of SMM at labor and delivery (Aim 1), incidence rate of SMM-related hospitalizations at 1-month and 1-year postpartum (Aim 1a), rate of preeclampsia diagnosis (Aim 2), change in perceived social support domains (Aim 3), and physical activity trajectories (exploratory Aim 4). Findings from this study will help to determine how to feasibly implement an effective and sustainable integrated care approach to address SMM disparities.

项目摘要/摘要：美国存在重大的健康危机 不成比例地影响黑人生日的人。黑人生日的人体验的可能性要高两倍 严重的孕产妇发病率（SMM） - “劳动和分娩的意外结果，导致重大 与非西班牙裔白人生日的人相比，短期或长期后果对生日的人的健康造成了。 预防先兆子痫，增加或保持参与健康行为（例如身体活动）， 支持解决与健康相关的社会需求的支持可以增强及时，适当的护理和 降低SMM的风险。 Northwell Health实施的孕产妇成果（妈妈）计划是 有效识别和支持高风险生日的有效综合护理方法 送货。在基于2500名参与者的数据的初步分析中，妈妈计划显着 黑人参与者中，与SMM有关的住院30天的风险降低了77％。 承诺这些初步发现；但是，长期有效性需要确定为 以及将妈妈计划扩展到产前时期的可行性和有效性。 这项研究的目的是测试两个不同的综合护理模型方法的有效性 强度水平旨在促进及时，适当照顾高风险的黑人生日，并减少 SMM的风险。黑人生日的人具有妇产科指数评分3和/或 将通过电子健康记录确定子痫，674将在 两个研究武器之一的妊娠中期：妈妈高touch（妈妈）与妈妈低调（妈妈 - LT）。 Moms-HT将包括通过聊天机器人技术和 在整个产前和产后期间，妈妈团队的及时护理和服务导航； 在产前期间，每两周一次的自我管理支持与妈妈团队联系；和4周 妈妈团队的导航后，产后临床检查通话立即交付后。妈妈-lt 还将包括通过聊天机器人进行临床和行为健康监控以及服务导航 妈妈团队和每周的4个周期产后临床检查通话。两个研究的武器将是 比较SMM在人工和分娩时的事件（AIM 1），与SMM相关住院的事件率 在产后1个月和1年（AIM 1A），先兆子痫的诊断率（AIM 2），感知到感知的变化 社会支持领域（AIM 3）和体育活动轨迹（探索目的4）。从中的发现 研究将有助于确定如何实施有效且可持续的综合护理方法 解决SMM分布。