A Pragmatic Trial of Integrating Community-based Patient Navigation into the Continuum of Maternal Care for Black Women in a Safety-Net Health System: Effects on Maternal Health, Health Care, Morbidit

将基于社区的患者导航纳入安全网卫生系统中黑人妇女连续孕产妇护理的务实试验：对孕产妇健康、医疗保健、发病率的影响

• 批准号: 10709629
• 负责人: Rasheeta Chandler
• 金额: $ 71.73万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709629
• 关键词: Address; Adoption; Birth; Black race; Caring; Chronic; Clinical; Communities; Community Health; Data; Data Reporting; Developed Countries; Discrimination; Disparity; Dose; Effectiveness; Elements; Equity; Evaluation; Event; Familiarity; Health; Health Personnel; Health Services; Health system; Healthcare; Hospitals; Improve Access; Inequity; Institution; Institutional Racism; Intervention; Interview; Life; Low income; Maternal Health; Maternal Health Services; Maternal Mortality; Maternal health equity; Measures; Mediator; Mental disorders; Methods; Modeling; Morbidity - disease rate; Mothers; National Institute on Minority Health and Health Disparities; Outcome; Participant; Patients; Perception; Perinatal; Policies; Politics; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Rate; Prenatal care; Preventive care; Primary Care; Process; Quality of Care; Questionnaires; Race; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Review Committee; Sample Size; Severities; Shapes; Social support; Stress; System; Testing; Time Management; Uninsured; Weather; Woman; arm; black women; community based research; cultural competence; depressive symptoms; design; disparity reduction; effectiveness evaluation; ethnic minority; evidence base; experience; health care quality; health care service utilization; health equity; implementation intervention; implicit bias; improved; informant; intervention delivery; maternal morbidity; meetings; metropolitan; mortality; multidisciplinary; patient navigation; patient navigator; postpartum care; pragmatic trial; prenatal; prevent; preventable death; primary outcome; process evaluation; racial disparity; racial minority; racism; recruit; safety net; scale up; secondary outcome; severe maternal morbidity; social; stress symptom; substance use

ABSTRACT US maternal mortality is substantially higher than that of other developed nations, with Georgia ranking second highest among the states. Maternal mortality and severe maternal morbidity (SMM) are increasing in Georgia, with the highest rates among those who are Black, publicly insured or uninsured, and deliver in safety-net hospitals. Maternal morbidity and mortality occur on a continuum in which the accumulation and progression in severity of events can be prevented through access to and utilization of quality health care. Georgia’s Maternal Mortality Review Committee concludes that two-thirds of maternal deaths are preventable and attributes recent increases to rising rates of inadequately managed chronic health conditions, mental health disorders, substance use, and pregnancy complications in the setting of care that is often difficult to access, fragmented and of insufficient quality. Experts emphasize that equity-centered health care approaches – which embed transformational aspects into their design through stakeholder input and Black-led models of care that include social support to counter stress related to racism and weathering – offer the most promise for reducing inequities. Emerging data support that the incorporation of racially-concordant, community-based patient navigators can enhance the cultural-competence of care while addressing discrimination, systemic racism, and institutional barriers to quality care. To date, however, limited research has evaluated this promising strategy in real-life settings using rigorous methods with sufficient sample size and ascertainment of morbidity and mortality endpoints critical for determining effectiveness and motivating large-scale policy and practice change. We posit that the integration of community-based patient navigators into maternal care will improve maternal health outcomes through meeting social needs, lowering stress and depressive symptoms, and improving access to and utilization of care thereby promoting better and more timely management of conditions and reducing the occurrence and progression of complications. To test this hypothesis, we propose to perform a pragmatic randomized controlled trial (RCT) of the integration of community-based patient navigators into the continuum of maternal care, starting prior to mid-pregnancy and continuing through one-year of birth, among 500 Black women with identified health and social needs in a safety-net hospital system to include both outcome evaluation, to discern effectiveness in reducing maternal morbidity and mortality, and process evaluation, to enhance understanding of RCT findings. We will employ the Respectful Maternity Care and the NIMHD Research Frameworks to rigorously evaluate maternal health outcomes in a hospital system that primarily serves Black women with high unmet needs who experience excessive rates of adverse maternal health outcomes via a multi-disciplinary team experienced in health services and community-based research, equity-centered care, and with the capacity to implement a care model intervention with high fidelity and acquire and utilize health system and patient-reported data to conduct comprehensive, high-quality evaluation.

摘要