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

项目摘要/摘要 在美国，产妇死亡率和严重的产妇发病率正在增加，尽管大多数 如果及时和适当的护理，这些结果是可以预防的。大多数医疗救护人员都不是最好的 精通产妇急诊护理，包括产妇心脏急救 逮捕。这种差距存在于急救人员和医学专科之间，甚至存在于产科专家之间 接受过高级心血管生命支持方面的培训。妇女保健和妇女保健领域的领先组织 复苏都呼吁努力让医护人员(HCW)更好地为产妇医疗做好准备 紧急情况，越来越多的联邦机构和州立法机构正在激励或要求医院 提供这种教育和培训。尽管如此，对孕产妇实施循证教育 美国各地卫生系统的医疗紧急情况不一致，国家认证标准也不一致 不存在。研究小组开发了产科生命支持TM(OBLSTM)，这是第一个此类跨学科的 为医院和院前医务工作者提供预防、识别和管理培训的模拟课程 产妇的紧急医疗事件。一项随机交叉试验的初步数据显示， 与干预组相比，干预组的临床能力、知识和信心有所提高 控制。到目前为止，OBLSTM培训已经在高资源环境中与卫生工作者一起实施，可以访问 最佳复苏资源(例如，大量输血方案、体外膜氧合、 医疗响应人员接受过复苏剖腹产方面的培训)。然而，卫生工作者在农村和资源匮乏 环境可能面临不同的压力(例如，财务、劳动力短缺、基础设施不发达) 来自高资源环境，并需要适应OBLSTM的学习目标、内容和交付 在这些情况下优化医疗急救的模式。该项目的目标是适应OBLSTM 在农村和资源匮乏的环境中实施。农村的定义将基于城乡通勤 区域(RUCA)代码。低资源设置是指DIMES三月指定的低资源或没有资源的县 获得产妇护理的机会。这项研究将在康涅狄格州大学健康中心与东北大学合作进行 农村医院协会和达特茅斯农村紧急服务和创伤健康中心。这个 实施研究和干预映射综合框架将指导实施 规划和适应过程。具体地说，这项研究的目的是：(1)确定障碍和促进者 在农村和低资源环境实施OBLSTM；(2)系统地使OBLSTM适用于卫生工作者 在农村和低资源环境中实践；以及(3)实施和评估适应课程(OBLSTM -远程访问)在新英格兰的农村社区。将采用混合方法的方法。 这项研究的结果将被用来促进这一重要的医疗创新在全国范围内的推广 改善患者安全和减少产妇发病率和死亡率方面的不平等的目标。

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.