Reducing Racial Disparities in SMM post COVID19: Assessing the integration of maternal safety bundles and community based doulas to improve outcomes for Black women

摘要（项目摘要） 与白人相比，黑人女性在怀孕护理、并发症和结果方面存在明显差异 妇女。识别、跟踪和理解严重孕产妇死亡 (SMM) 的模式及相关 种族/民族的不平等，以及制定和实施干预措施以提高教育质量 孕产妇护理对于降低 SMM 从而降低孕产妇死亡率至关重要。迄今为止，已经很少有 研究专门旨在了解黑人是否经历了孕产妇健康不平等 可以通过综合护理模式来改善妇女的状况，其中包括有色人种母亲的参与 除了产前、分娩和产后之外，孕产妇安全捆绑包的规划和实施 来自社区导乐师的支持。我们打算使用健康影响金字塔来开发、实施和 评估该系统在减少 SMM 和死亡率差异方面的有效性。数据来源为 这项研究将包括作为联盟的一部分收集的州级和特定医院的出院数据 孕产妇保健创新（AIM）项目；孕产妇死亡率审查委员会（MMRC）；和 妊娠至生命早期纵向 (PELL) 数据系统，重点关注怀孕至生命早期所需的人口水平数据 检查马萨诸塞州少数种族和族裔之间的健康不平等。除了这些现有的 数据来源，我们打算建立一个数据收集工具来评估导乐服务以及分析 来自黑人女性访谈的定性数据，以及与提供者和助产士的焦点小组探讨 将导乐提供的服务纳入产前、分娩和产后护理的效果。该提案有 三个主要研究领域将导致系统地了解解决和预防 SMM 的方法 黑人女性，从而为未来的开发、测试和扩大奠定基础 改善孕产妇健康结果的干预措施：1) 使用纵向关联的出院数据 PELL（2008-2018）描述女性受孕前、产前和产后医院经历的特征 与 SMM 合作，以确定错过干预机会的关键点。 2): 医院之间 为黑人妇女服务，评估实施孕产妇安全捆绑包的影响，以确保黑人妇女 妇女正在接受优质产科护理 3)：检查系统如何整合基于社区的导乐 支持可以减少 SMM 在黑人和白人母亲中的不平等。我们的研究将带来更多 系统地了解 SMM 风险最高的黑人女性的妊娠结局，从而建立一个 为开发和测试未来改善孕产妇结局的干预措施奠定基础。

Abstract (Project Summary) Black women experience stark disparities in pregnancy care, complications, and outcomes, compared to White women. Recognizing, tracking and understanding patterns of severe maternal mortality (SMM) and associated inequities by race/ethnicity, along with developing and carrying out interventions to improve the quality of maternal care, are essential to reducing SMM and thereby maternal mortality. To date, there has been little research specifically aimed at understanding whether the maternal health inequities as experienced by Black women can be ameliorated through an integrated care model that includes engagement of mothers of color in the planning and implementation of maternal safety bundles in addition to prenatal, birth and postpartum support from community doulas. We intend to use the Health Impact Pyramid to develop, implement and assess the effectiveness of such a system in reducing disparities in SMM and mortality. The data sources for this study will include state-level and hospital-specific discharge data collected as part of the Alliance for Innovation on Maternal Health (AIM) project; the Maternal Mortality Review Committee (MMRC); and the Pregnancy to Early Life Longitudinal (PELL) data system, which focuses on population-level data needed to examine health inequities among racial and ethnic minorities in Massachusetts. In addition to these existing data sources, we intend to establish a data collection tool to assess doula services as well as analyze qualitative data from interviews with black women, and focus groups with providers and doulas to explore the effect of incorporating doula-provided services into prenatal, birth and postpartum care. This proposal has three main study areas that will lead to a systematic understanding of ways to address and prevent SMM among black women and thus, establish a foundation for the development, testing and scale-up of future interventions to improve maternal health outcomes: 1) Use longitudinally linked hospital discharge data from PELL (2008-2018) to characterize preconception, prenatal and postpartum hospital encounters among women with SMM in order to identify key points where opportunities to intervene were missed. 2): Among hospitals that serve black women, to assess the impact of implementing maternal safety bundles to ensure that black women are receiving quality obstetric care 3): Examine how systems integrating community-based doula support could decrease the inequities of SMM among black and white mothers. Our study will lead to a more systematic understanding of pregnancy outcomes for Black women at highest risk of SMM, thus establishing a foundation for development and testing of future interventions to improve maternal outcomes.