Brooklyn Digital Community Care Intervention to Address Unmet Social Needs and Optimize Engagement in Maternal Health Care

项目摘要 布鲁克林中心是纽约市孕产妇健康危机的中心。率最高 严重孕产妇发病率（SMM），被认为是“险些”孕产妇死亡，发现在 黑人移民妇女，集中在布鲁克林中部。这种情况反映了一种 系统性种族主义和忽视的历史。在整个怀孕期间缺乏适当护理的妇女 和产后有更高的SMM和死亡风险。为了应对这场公共卫生危机，我们将 测试名为We Care的新型干预原型的初步功效和可接受性 关于布鲁克林（WeCAB），它整合了以证据为基础的以社区为中心的原则， 护理模式，并雇用社区卫生工作者（CHW）与家庭联系并提供支持 同时利用数字社会健康决定因素（SDOH）筛查和闭环转诊 系统我们假设，全面解决SDOH（基本生存需求，如 粮食安全、体面住房和儿童保育）将减少医疗保健利用的障碍， 改善整个孕期和产后期间的护理工作。我们提出了一个 混合方法研究设计，具有以下特定目标：1）定制现有的数字SDOH 布鲁克林中心的筛选工具，并建立临床医生，客户和社区利益相关者适合 告知CHW干预培训方案; 2）在中环进行WeCAB试点RCT 布鲁克林孕产妇人口，以衡量该系统的可接受性和初步功效; 3)确定障碍和促进因素，以采用和整合我们的干预原型， 通过关键知情人访谈和干预后调查，开展常规孕产妇护理。WeCAB 在美国历史上， 遭受不成比例的不良健康负担的边缘化孕产妇群体 成果。

Project Abstract Central Brooklyn is the epicenter of the maternal health crisis in New York City. The highest rates of severe maternal morbidity (SMM), considered “near misses” to maternal death, are found in Black immigrant women, who are concentrated in Central Brooklyn. This situation reflects a history of systemic racism and neglect. Women who lack adequate care throughout pregnancy and post-partum are at higher risk of SMM and death. To address this public health crisis, we will test the preliminary efficacy and acceptability of novel intervention prototype called We Care About Brooklyn (WeCAB), which integrates principles of an evidence-based community-centered care model and employs community health workers (CHWs) to connect with and support families while leveraging a digital social determinants of health (SDOH) screening and closed-loop referral system. We hypothesize that comprehensively addressing SDOH (basic survival needs such as food security, decent housing, and childcare) will reduce barriers to healthcare utilization and improve engagement in care throughout pregnancy and the post-partum period. We propose a mixed-methods study design with the following specific aims: 1) tailor the existing digital SDOH screening tool for Central Brooklyn and build clinician, client and community stakeholder fit to inform the CHW intervention training protocol; 2) conduct a pilot RCT of WeCAB in the Central Brooklyn maternal population to measure acceptability and preliminary efficacy of the system; and 3) identify barriers and facilitators to the adoption and integration of our intervention prototype into routine maternal care through key informant interviews and a post-intervention survey. WeCAB has the long-term potential to improve health during and after pregnancy in America’s historically marginalized maternal populations who experience a disproportionate burden of adverse health outcomes.