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（Project Summary） 与白色妇女相比，黑人妇女在怀孕护理、并发症和结局方面存在明显差异 妇女认识、跟踪和了解严重孕产妇死亡率和相关死亡率的模式 沿着制定和实施干预措施， 产妇保健对减少SMM和产妇死亡率至关重要。迄今为止， 一项专门旨在了解布莱克所经历的孕产妇健康不公平现象的研究 妇女可以通过综合护理模式得到改善，包括有色人种母亲的参与， 除了产前、分娩和产后外，还规划和实施孕产妇安全包; 社区导卫的支持。我们打算利用健康影响金字塔来制定、实施和 评估这一系统在减少最低保证医疗率和死亡率方面的差距方面的有效性。的数据源 这项研究将包括作为联盟的一部分收集的州一级和医院特定的出院数据， 产妇保健创新项目;产妇死亡率审查委员会; 妊娠至生命早期纵向（PELL）数据系统，侧重于人口水平数据， 研究马萨诸塞州少数种族和民族之间的健康不平等。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，以评估导乐服务，以及分析 从与黑人妇女的访谈中获得的定性数据，以及与提供者和导乐师的焦点小组，以探讨 将助产服务纳入产前、分娩和产后护理的效果。这一建议 三个主要的研究领域，将导致系统地了解如何解决和预防SMM 因此，为未来的发展、测试和扩大规模奠定了基础。 改善产妇健康结果的干预措施：1）使用纵向联系的出院数据， PELL（2008-2018年），以描述妇女在怀孕前、产前和产后医院的遭遇 与SMM合作，以确定错过干预机会的关键点。2）：在医院中 为黑人妇女服务，以评估实施孕产妇安全包的影响，以确保黑人妇女 3）：研究如何将社区导乐与产科护理相结合， 支持可以减少黑人和白色母亲之间SMM的不平等。我们的研究将带来更多 系统地了解SMM风险最高的黑人妇女的妊娠结局，从而建立一个 为制定和测试未来的干预措施以改善孕产妇结局奠定基础。

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.