Adaptation of an Evidence-Based Curriculum to Teach the Prevention, Evaluation and Treatment of Maternal Medical Emergencies for Pre-hospital & Hospital Healthcare Workers in Rural Context

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PROJECT SUMMARY/ABSTRACT Maternal mortality and severe maternal morbidity are increasing in the United States (US) despite most of these outcomes being preventable with timely and appropriate care. Most medical responders are not optimally proficient in caring for patients who experience maternal medical emergencies, including maternal cardiac arrest. This gap exists among first responders and across medical specialties, and even for OB-specialists trained in Advanced Cardiovascular Life Support. Leading organizations in women’s health care and resuscitation have all called for efforts to better prepare healthcare workers (HCWs) for maternal medical emergencies, and increasingly federal agencies and state legislatures are incentivizing or requiring hospitals to provide this education and training. Nonetheless, the implementation of evidence-based education for maternal medical emergencies in health systems across the US is inconsistent and national credentialing standards do not exist. The study team developed Obstetric Life SupportTM (OBLSTM), the first of its kind interdisciplinary simulation curriculum to train hospital-based and prehospital HCWs on preventing, recognizing, and managing maternal medical emergencies. Preliminary data from a randomized, cross-over trial shows significant improvement in clinical competencies, knowledge, and confidence for the intervention group compared to the controls. To date, OBLSTM training has been implemented with HCWs in high-resource settings with access to optimal resuscitation resources (e.g., massive transfusion protocol, extracorporeal membrane oxygenation, medical responder trained in resuscitative cesarean delivery). However, HCWs in rural and low-resource settings may face pressures (e.g., financial, workforce shortages, underdeveloped infrastructure) that differ from high-resource settings, and require adaptations to OBLSTM’s learning objectives, content, and delivery mode to optimize medical emergency care in these contexts. The objective of this project is to adapt OBLSTM for implementation in rural and low-resource settings. Rural will be defined based on Rural-Urban Commuting Area (RUCA) codes. Low-resource settings are counties designated by March of Dimes as having low or no access to maternity care. The study will be conducted at UCONN Health in partnership with the Northeast Rural Hospital Association and the Dartmouth Health Center for Rural Emergency Services and Trauma. The Consolidated Framework for Implementation Research and Intervention Mapping will guide the implementation planning and adaptation process. Specifically, the study aims to: (1) Identify barriers and facilitators to implementation of OBLSTM in rural and low-resource settings; (2) Systematically adapt OBLSTM for HCWs practicing in rural and low-resource settings; and (3) Implement and evaluate the adapted curriculum (OBLSTM – Remote Access) in rural communities in New England. A mixed methods approach will be employed. Findings from this study will be used to promote national scale-up of this important health care innovation with the goal of improving patient safety and reducing inequities in maternal morbidity and mortality.