IC-CSRisk Study: Implementation of Calculated Cesarean Section Risk during labor induction, a multi-site stepped-wedge randomized rollout trial
IC-CSRisk 研究:引产期间计算剖腹产风险的实施,一项多站点阶梯式楔形随机推广试验
基本信息
- 批准号:10776163
- 负责人:
- 金额:$ 191.89万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-22 至 2026-08-31
- 项目状态:未结题
- 来源:
- 关键词:AffectBiometryBirthBlack raceBlack, Indigenous, People of ColorBody mass indexCaringCatalogsCervicalCesarean sectionChild DevelopmentChild HealthClinicalClinical effectivenessColorConsolidated Framework for Implementation ResearchDataDecision MakingDiscipline of obstetricsDisparityEpidemiologyEquationEquityEvidence based interventionEvidence based practiceFoundationsFutureGeographyGestational AgeGoalsHealthHeightHemorrhageInduced LaborInterventionInterviewMapsMaternal HealthMaternal health equityMethodologyMethodsMissionMorbidity - disease rateOutcomePatientsPenetrationPersonsPopulationPregnancy OutcomeProspective, cohort studyRaceRandomizedReduce health disparitiesResearchResearch DesignResearch PersonnelRiskRisk ReductionSiteStandardizationSurgical Wound InfectionSurveysSystemTestingUnited StatesVariantVisionWomanWorkclinically significantdemographicsdesigndisparity reductioneffectiveness evaluationeffectiveness studyeffectiveness/implementation hybrideffectiveness/implementation trialethnic diversityexperienceexplicit biasfallshigh riskimplementation determinantsimplementation evaluationimplementation outcomesimplementation researchimplementation scienceimplementation strategyimplicit biasimprovedinnovationinterestmaternal morbiditymortalitynovelobstetric outcomesparitypersonalized risk predictionracial disparityresponserisk predictionrisk prediction modelsuccess
项目摘要
PROJECT SUMMARY
In the United States, over four million women give birth annually, with more than 20% undergoing labor
induction. One-third of inductions end in cesarean delivery, which are associated with increased maternal
morbidity. In the US, there are also significant, unacceptable disparities between Black, Indigenous, People of
Color (BIPOC) and non-BIPOC birthing people in cesarean rates and maternal morbidity. Outside obstetrics,
interventions that increase objectivity and decision-making standardization have been shown to limit the effects
of bias on health outcomes. In response, our group created a risk prediction model for cesarean among those
undergoing induction, which provides clinicians and patients with an individualized percentage risk of cesarean
for a given patient’s labor induction. In a single-site prospective cohort study, use of this cesarean risk
calculator was associated with substantial improvements in cesarean delivery rate and maternal morbidity.
Through mixed-methods work, we elucidated the calculator’s mechanisms of success: plausibly assisting
clinicians in objective decision-making, particularly for patients at very low or very high risk of cesarean,
The central hypothesis of this proposal is that, with a foundation in implementation science,
implementation of the cesarean risk calculator at diverse labor units across the US can have a profound impact
on critical obstetric outcomes for all birthing people, with a particular focus on patients of color. This proposal
leverages experienced investigators in maternal health equity (PI Hamm, Co-Is Levine, Howell, Clark, and
Hussey), implementation science (PI Hamm, Co-I Lane-Fall, Delgado, Stephens), biostatistics/epidemiology of
implementation (Co-I Stephens), and mixed methods (PI Hamm, Co-I Lane-Fall).
We plan to test our hypothesis by studying the effectiveness of the cesarean risk calculator, while
simultaneously collecting implementation data in a type I hybrid effectiveness-implementation, randomized
stepped-wedge rollout design across 14 committed labor units. Before the rollout begins, Aim 1 will evaluate
and catalogue contextual determinants at all included sites included in order to map implementation strategies
and workflow plans most likely to result in successful local implementation. Aim 2 will then determine
effectiveness of the cesarean risk calculator in the stepped wedge design, with planned stratified analysis by
patient race to evaluate calculator impact on disparities. Finally, Aim 3 will determine calculator acceptability,
penetration, and equitable reach in a mixed-methods approach.
By the conclusion of this work, we will have novel, clinically important information on the impact of the
cesarean risk calculator on labor outcomes, and an online toolkit for widespread implementation. The results of
this proposed R01 will also produce data generalizable to many future large-scale implementation endeavors
designed to improve maternal health.
项目总结
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Rebecca Feldman Hamm其他文献
Letter to the editor of implementation science in response to “Implementation Science in maternity care, A scoping Review” by Dadich, Piper, and Coates (2021)
- DOI:
10.1186/s13012-021-01129-9 - 发表时间:
2021-08-16 - 期刊:
- 影响因子:13.400
- 作者:
Rachel Blankstein Breman;Rebecca Feldman Hamm;Jennifer A. Callaghan-Koru - 通讯作者:
Jennifer A. Callaghan-Koru
Rebecca Feldman Hamm的其他文献
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{{ truncateString('Rebecca Feldman Hamm', 18)}}的其他基金
Achieving Maternal Equity and Transforming Health through Implementation Science and Training (AMETHIST@Penn)
通过实施科学和培训实现孕产妇公平并改变健康状况 (AMETHIST@Penn)
- 批准号:
10748593 - 财政年份:2023
- 资助金额:
$ 191.89万 - 项目类别:
A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort study
减少初次剖宫产和分娩结果种族差异的标准化引产方案:一项前瞻性队列研究
- 批准号:
10680428 - 财政年份:2020
- 资助金额:
$ 191.89万 - 项目类别:
A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort study
减少初次剖宫产和分娩结果种族差异的标准化引产方案:一项前瞻性队列研究
- 批准号:
10468139 - 财政年份:2020
- 资助金额:
$ 191.89万 - 项目类别:
A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort study
减少初次剖宫产和分娩结果种族差异的标准化引产方案:一项前瞻性队列研究
- 批准号:
10249292 - 财政年份:2020
- 资助金额:
$ 191.89万 - 项目类别:
A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort study
减少初次剖宫产和分娩结果种族差异的标准化引产方案:一项前瞻性队列研究
- 批准号:
10038654 - 财政年份:2020
- 资助金额:
$ 191.89万 - 项目类别:
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