Epidemiology of prehospital obstetric conditions and out-of-hospital deliveries in the US

美国院前产科疾病和院外分娩的流行病学

• 批准号: 10709893
• 负责人: Rebecca E Cash
• 金额: $ 25.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10709893
• 关键词: Admission activity; Area; Birth; Caring; Characteristics; Clinical; Communities; Complex; Country; Data; Data Set; Development; Discipline of obstetrics; Education; Educational Curriculum; Emergency Care; Emergency Medicine; Emergency Situation; Emergency medical service; Emergency response; Emergency treatment; Epidemiology; Event; Frequencies; Future; Goals; Guidelines; Health Personnel; High Risk Woman; High-Risk Pregnancy; Home; Hospitals; Human Resources; Infant Care; Information Systems; Intervention; Intervention Studies; Knowledge; Maternal Age; Maternal Mortality; Maternal and Child Health; Maternal complication; Methodology; Methods; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Neonatal; Neonatal Intensive Care Units; Neonatology; Newborn Infant; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Policy Developments; Postpartum Hemorrhage; Pre-hospital setting; Pre-hospitalization care; Pregnancy; Pregnant Women; Premature Birth; Prevention; Provider; Race; Recommendation; Records; Research; Research Priority; Risk; Sampling; Services; Statistical Data Interpretation; System; Time; Training; Training and Education; Triage; Urbanicity; Woman; Work; care systems; child services; clinical care; emergency settings; evidence based guidelines; experience; high risk; hospital patient care; improved; interest; mortality; natural hypothermia; neonatal death; neonatal resuscitation; obstetric care; obstetric outcomes; out-of-hospital cardiac arrest; patient safety; repository; rural area; social vulnerability

PROJECT SUMMARY Thousands of unplanned births occur at home in the US each year, and most trigger 911 emergency medical services (EMS) activations (i.e., calls for service). For these high-risk patients, evidence from other countries suggest unplanned out-of-hospital delivery (OHD) is associated with an increased risk of postpartum hemorrhage, neonatal hypothermia, neonatal intensive care unit admission, and maternal and neonatal death. However, little is known about the epidemiology and patient safety of OHD and other obstetric conditions treated by EMS personnel in the US. These major knowledge gaps have resulted in the lack of any evidence-based guidelines for EMS care of an obstetric patient and an ongoing lack of prehospital-specific training in this major area of maternal and child health. The overarching objective of this exploratory R21 project is to better understand the characteristics and clinical care of prehospital obstetric conditions treated by EMS personnel to inform future interventions that will reduce morbidity and mortality and improve prehospital patient care. We will use a national repository of EMS patient care records, the National Emergency Medical Services Information System (NEMSIS), to investigate prehospital care of mothers and their newborn infants. Collectively, from January 2018 to December 2019, NEMSIS includes >50 million EMS patient care records from 47 states and territories and over 10,000 EMS agencies, representing the largest sample of prehospital care records available. In Aim 1, we will describe the patient, community, emergency response, and clinical characteristics of OHDs and other high-risk obstetric conditions treated by EMS personnel, including examining differences by key factors like urbanicity, community-level racial distribution, and maternal age. In Aim 2, we will examine the frequency and prehospital factors associated with patient safety events during OHD and maternal and neonatal resuscitation. In Aim 3, we will use a modified Delphi method with a panel of 10-18 clinical and EMS experts to identify research priorities to improve prehospital care of obstetric conditions. Based on our pilot data, we estimate identifying approximately 7,000 EMS activations for OHD, with over 80% power for the statistical analyses in Aims 1 and 2. The present R21 project will provide a unique opportunity for the first national description of EMS care of obstetric patients in the US and prehospital-specific research priorities to guide research and interventions to improve prehospital patient outcomes and safety. This study directly responds to the NICHD priority to improve treatment of women at high risk for pregnancy-related morbidities and mortality; the Notice of Special Interest in Research on Emergency Medical Services for Children (NOT-HD-19-022); the Notice of Special Interest in Research in the Emergency Setting (NOT-NS-20-005); and the Healthy People 2030 objectives to reduce maternal deaths and severe maternal complications.

项目摘要 在美国，每年有数千例计划外生育发生在家中，其中大多数引发了911紧急医疗救助。 服务（EMS）激活（即，服务要求）。对于这些高危患者，来自其他国家的证据表明， 提示计划外院外分娩（OHD）与产后 出血、新生儿体温过低、新生儿重症监护室入院以及孕产妇和新生儿死亡。 然而，关于OHD和其他产科疾病的流行病学和患者安全性知之甚少 美国的EMS人员。这些重大的知识差距导致缺乏任何基于证据的 产科病人的EMS护理指南，以及目前缺乏这一专业的院前专门培训 妇幼保健领域。这个探索性的R21项目的首要目标是更好地 了解EMS人员治疗的院前产科状况的特点和临床护理， 为未来的干预措施提供信息，这将降低发病率和死亡率，并改善院前病人护理。我们将 使用EMS患者护理记录的国家存储库，国家紧急医疗服务信息 系统（NEMSIS），调查母亲及其新生儿的院前护理。总的来说，从 2018年1月至2019年12月，NEMSIS包括来自47个州的超过5000万份EMS患者护理记录， 地区和超过10，000 EMS机构，代表了最大的样本的院前护理记录可用。 在目标1中，我们将描述OHD的患者、社区、应急响应和临床特征， EMS人员治疗的其他高危产科疾病，包括检查关键因素的差异 比如城市化、社区层面的种族分布和母亲年龄。在目标2中，我们将检查频率 与OHD期间患者安全事件相关的院前因素以及孕产妇和新生儿 复苏术在目标3中，我们将使用一种改进的德尔菲法，由10-18名临床和EMS专家组成的小组， 确定研究重点，以改善产科状况的院前护理。根据我们的试点数据，我们 估计识别出约7，000例OHD EMS激活，统计功效超过80% 目标1和2的分析。目前的R21项目将为第一个国家级项目提供独特的机会。 描述美国产科患者的EMS护理和院前特定研究优先事项，以指导 研究和干预措施，以改善院前病人的预后和安全。这项研究直接回应了 国家排雷中心优先改善对妊娠相关疾病和死亡风险高的妇女的治疗; 《关于开展儿童急诊医疗服务研究的通知》（NOT-HD-19-022）; 紧急情况下特别关注研究的通知（NOT-NS-20-005）;和健康人群2030 目标是减少产妇死亡和严重的产妇并发症。