NHLBI Community Engagement Technical Assistance Center (CETAC)

NHLBI 社区参与技术援助中心 (CETAC)

• 批准号: 10840026
• 负责人: Chanza Baytop
• 金额: $ 1396.62万
• 依托单位: WESTAT, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10840026
• 关键词: Address; Affect; Area; Behavior; Behavioral; Biological; Black race; Cardiomyopathies; Cardiovascular system; Caring; Cause of Death; Clinical; Communities; Complex; Conceptions; Coping Behavior; Development; Discrimination; Eclampsia; Embolism; Ensure; Environmental Risk Factor; Ethnic Origin; Exposure to; Family; Funding Opportunities; Future; Gestational Diabetes; Goals; Health; Health Disparities Research; Health Priorities; Health Sciences; Health Status; Healthcare Systems; Hemorrhage; Hypertension; Infection; Infrastructure; Life Cycle Stages; Longevity; Maternal Health; Maternal Mortality; Mental Health; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Needs Assessment; Not Hispanic or Latino; Obesity; Outcome; Play; Population Heterogeneity; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Primary Care; Psyche structure; Race; Research; Risk Factors; Role; Scientist; Sleep Disorders; Smoking; Strategic Planning; Strategic vision; Stress; Support Groups; Testing; United States; United States National Institutes of Health; Woman; Women' s Health; Work; antenatal; caregiving; community engagement; community organizations; community partnership; evidence base; experience; implicit bias; improved; insight; intrapartum; maternal morbidity; mortality; opioid use; programs; protective factors; psychologic; social; social determinants; theories; trend

Over the past three decades, there have been alarming upward trends in the rates of maternal morbidity and mortality in the United States. Overall, the identified clinical causes of maternal death are: cardiovascular conditions (14%), hemorrhage (13%), infection (11%) embolism (10%), cardiomyopathy (95), mental health conditions (9%) and preeclampsia/eclampsia (8%) but these conditions vary by race/ethnicity. For Black, non-Hispanic women, the two leading causes of death were cardiomyopathy and cardiovascular conditions, and mental conditions was the leading cause among White, non-Hispanic women.1 Obesity, hypertension, smoking, opioid use and sleep disorders are also conditions and behaviors that have been found to be associated with maternal morbidity such as hemorrhage, preeclampsia and cardiomyopathy. These could potentially be addressed in primary care before and between pregnancies.2-6 The National Heart, Lung Blood Institute (NHLBI) is participating in a trans-National Institutes of Health (NIH) effort to improve women’s health, particularly maternal morbidity and mortality. A plan – Advancing Science for the Health of Women, The Trans-NIH Strategic Plan for Women’s Health Research – was developed for the period 2019 – 2023. This plan provides a framework that recognizes the complex interactions of multiple factors that affect women’s health across the life course, including pregnancy. Life course theory posits that health development begins before conception and continues across the life span. It suggests that a complex play of biologic, behavioral, psychological, and social protective and risk factors contribute to health outcomes, and that health status reflects the cumulative lifetime exposure to these factors. The guiding principles for this plan are consideration of the complex factors affecting women’s health, the inclusion of diverse populations that are disproportionately affected by morbidity and mortality, and active engagement of a diverse group of scientists.7 The NIH approach to reducing maternal morbidity and mortality will aim to enhance health disparities research, increase the understanding of social determinants and other risk factors (including environmental risk factors), improve care (antepartum, intrapartum and postpartum) and management, provide insight to psychological exposures such as stress, discrimination and caregiving, understand coping behaviors in families affected by maternal morbidity or mortality, and investigate the role of implicit bias in the health care systems regarding pregnancy.8 Within NHLBI, maternal and women’s health priorities span all of the objectives of the NHLBI strategic vision, and NHLBI has supported a number of maternal health programs looking at hypertension, sleep disorders, and other pregnancy complications including pre-eclampsia, eclampsia, and gestational diabetes. The goal of the NHLBI 3M Administrative Coordinating Center (3M ACC) is to engage communities and networks in areas that experience high levels of maternal morbidity and mortality. The 3M ACC will support the preliminary work necessary to identify and prepare a group of community-based organizations to respond to future funding opportunities. The 3M ACC will develop the infrastructure to support this group of Maternal Morbidity and Mortality Regional Coalitions (3M RCs) and provide scientific support and coordination to NHLBI on emerging scientific needs. Specifically, the 3M ACC will support these programmatic objectives: • Identify research groups and organizations with existing and relevant expertise and community partnerships. • Conduct landscape analyses and community-informed needs assessments. • Identify within each community implementation opportunities and barriers to improve delivery of evidence-based care to reduce maternal morbidity and mortality. • Develop and conduct early-stage tests of implementation approaches to identify potential strategies to ensure the proposed approaches are acceptable, feasible, scalable, and sustainable and to identify barriers.

过去三十年来，孕产妇死亡率呈令人震惊的上升趋势 美国的发病率和死亡率。总体而言，已确定的孕产妇临床原因 死亡原因为：心血管疾病（14%）、出血（13%）、感染（11%）栓塞 (10%)、心肌病 (95)、精神健康问题 (9%) 和先兆子痫/子痫 (8%) 但这些条件因种族/民族而异。对于黑人、非西班牙裔女性来说，两个主要因素 死亡原因是心肌病、心血管疾病以及精神疾病 是白人、非西班牙裔女性的主要原因。1 肥胖、高血压、吸烟、 阿片类药物的使用和睡眠障碍也是已被发现的病症和行为 与出血、先兆子痫和心肌病等孕产妇疾病有关。 这些问题可能会在怀孕前和怀孕期间的初级保健中得到解决。2-6 国家心肺血液研究所 (NHLBI) 正在参与一项跨国家研究所 卫生署 (NIH) 致力于改善妇女健康，特别是孕产妇发病率和死亡率。一个 计划 – 推进科学促进妇女健康，跨 NIH 妇女战略计划 健康研究 – 为 2019 年至 2023 年期间制定。该计划提供了一个框架 认识到影响妇女健康的多种因素之间复杂的相互作用 生命历程，包括怀孕。生命历程理论认为健康发展始于 在受孕前并持续一生。它表明，复杂的游戏 生物、行为、心理和社会保护和风险因素有助于健康 结果，健康状况反映了一生中累积接触这些因素的情况。这 该计划的指导原则是考虑影响妇女地位的复杂因素 健康、包容受发病率影响不成比例的不同人群以及 死亡率，以及不同科学家群体的积极参与。7 美国国立卫生研究院降低孕产妇发病率和死亡率的方法旨在增强健康 差异研究，增加对社会决定因素和其他风险因素的理解 （包括环境风险因素）、改善护理（产前、产中和产后） 和管理，提供对心理暴露的洞察，例如压力、歧视和 护理，了解受孕产妇发病或死亡影响的家庭的应对行为， 并调查医疗保健系统中有关怀孕的隐性偏见的作用。8 NHLBI、孕产妇和妇女健康优先事项涵盖了 NHLBI 战略的所有目标 愿景，并且 NHLBI 支持了许多孕产妇保健项目，着眼于 高血压、睡眠障碍和其他妊娠并发症，包括先兆子痫、 子痫和妊娠糖尿病。 NHLBI 3M 行政协调中心 (3M ACC) 的目标是让 孕产妇发病率高的地区的社区和网络 死亡。 3M ACC 将支持确定和准备 一组以社区为基础的组织，以应对未来的融资机会。 3M ACC 将开发基础设施来支持这一群体的孕产妇发病率和死亡率 区域联盟 (3M RC) 并为 NHLBI 提供科学支持和协调 新出现的科学需求。具体来说，3M ACC 将支持以下计划目标： • 确定具有现有相关专业知识的研究小组和组织，以及 社区伙伴关系。 • 进行景观分析和社区知情的需求评估。 • 确定每个社区内的实施机会和改进障碍 提供循证护理以降低孕产妇发病率和死亡率。 • 制定并进行实施方法的早期测试，以确定潜在的潜力 确保所提出的方法是可接受的、可行的、可扩展的和可扩展的策略 可持续发展并找出障碍。