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

项目概要/摘要：美国存在孕产妇健康危机， 不成比例地影响黑人生育。黑人生育的人有两倍的可能性经历 严重孕产妇发病率（SMM）-“分娩和分娩的意外结果，导致严重的 短期或长期后果对一个人的健康生育”-比非西班牙裔白色生育的人。 预防先兆子痫，增加或维持健康行为的参与（例如，体力活动）， 和支持，解决与健康有关的社会需求，可以加强及时，适当的照顾， 降低SMM风险。在Northwell Health实施的孕产妇结局（MOMs）计划是一项 有效的综合护理方法，在分娩后立即识别和支持高危分娩人群， 交付.在基于2500名参与者数据的初步分析中，MOMs计划显著 在黑人参与者中，分娩后30天SMM相关住院的风险降低了77%。 这些初步研究结果是有希望的;然而，长期有效性需要确定， 以及将MOMs方案扩展到产前阶段的可行性和有效性。 本研究的目的是测试综合护理模式方法在两个不同的 强度水平，旨在促进及时，适当的照顾高风险的黑人分娩的人， 风险SMM。黑人分娩的人与产科并发症指数评分为10.3和/或历史的前 将通过电子健康记录识别子痫，并将招募674名患者， 两个研究组之一的前三个月：MOMs高接触（MOMs-HT）与MOMs低接触（MOMs- LT）。MOMs-HT将通过聊天机器人技术进行密切的临床和行为健康监测， 在整个产前和产后期间，由MOMs团队提供及时的护理和服务; 在产前期间，每两周与产妇管理小组进行12次自我管理支持电话会议; 产后临床登记电话，产后立即由MOMs团队进行导航。MOMs-LT 还将包括通过聊天机器人进行临床和行为健康监测沿着以及通过 MOMs团队和4个每周一次的带导航的产后临床检查电话。两个研究组将 比较分娩和分娩时SMM的发生率（目标1），SMM相关住院的发生率 产后1个月和1年（目标1a），先兆子痫诊断率（目标2）， 社会支持领域（目标3）和身体活动轨迹（探索性目标4）。时发现的问题 研究将有助于确定如何切实可行地实施有效和可持续的综合护理方法 解决SMM差异。

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.