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、并发症和结局方面存在明显差异 女人。认识、跟踪和了解严重孕产妇死亡(SMM)及其相关的模式 按种族/族裔划分的不平等现象，以及制定和开展干预措施，以提高 产妇保健对于减少SMM，从而降低孕产妇死亡率至关重要。到目前为止，几乎没有 研究专门旨在了解布莱克所经历的孕产妇健康不平等 妇女可以通过综合护理模式得到改善，这种模式包括让有色人种母亲参与 除产前、分娩和产后外，还规划和实施产妇安全包 来自社区杜拉的支持。我们打算使用健康影响金字塔来开发、实施和 评估这一系统在减少SMM差异和死亡率方面的有效性。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特定医院的出院数据 产妇保健创新项目；产妇死亡率审查委员会；以及 孕期到早期生命纵向(Pell)数据系统，其重点是人口层面的数据 调查马萨诸塞州种族和少数民族之间的健康不平等现象。除了这些现有功能之外 数据来源，我们打算建立一个数据收集工具来评估DOLA服务以及分析 来自对黑人女性的采访的定性数据，以及与提供者和Doula的焦点小组，以探索 将助产士提供的服务纳入产前、分娩和产后护理的效果。这项建议具有 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 在黑人妇女中，从而为未来的发展、测试和扩大奠定基础 改善孕产妇健康结果的干预措施：1)从以下方面使用纵向关联的出院数据 Pell(2008-2018)描述了女性在怀孕前、产前和产后在医院的遭遇 与SMM合作，以找出错失干预机会的关键点。2)：在医院之间 为黑人妇女服务，以评估实施孕产妇安全捆绑的影响，以确保黑人 妇女正在接受高质量的产科护理：检查整合社区助产士的系统 支持可以减少黑人和白人母亲之间SMM的不平等。我们的研究将导致更多的 系统性地了解患有SMM风险最高的黑人妇女的妊娠结局，从而建立 为今后改善产妇结局的干预措施的开发和测试奠定基础。

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.