"Maternal Outcome Monitoring and Support (MOMS) - A mHealth symptom self-monitoring and decision support system to reduce racial and ethnic disparities in postpartum outcomes

项目摘要/总结 在过去的二十年里，美国的严重孕产妇发病率（SMM）上升了120-200%， 专家估计，这些病例中有40-60%是可以预防的。 精神问题，虽然通常与SMM分开报告，是孕产妇死亡的第二大原因。 4，5其他不导致死亡的严重急性精神病事件（IAPE）未反映在 SMM的统计。改善举措主要是以医院为基础的，依靠妇女认识到， 他们自己的症状和寻求照顾没有充分的支持或教育。我们假设我们可以 通过帮助患者自我监测，提高患者的自我效能和何时寻求护理的决策能力 症状和提供决策支持。我们建议开发一个基于移动健康的，患者报告的 结果（PRO）和决策支持系统，以帮助母亲确定何时寻求护理的警告信号 的SMM。我们的项目重点关注面临产后差异的不同人群，特别是非洲人， 美国和西班牙语的拉丁妇女。长期目标是使本达博士能够利用这一点 工作到一个独立的研究计划，这将设计，评估和实施技术， 改善卫生公平性。利用威尔康奈尔医学院和外部顾问的强大资源， 在K99阶段，将开发和验证产后症状设计要求的框架 报告和决策支持需求。在R 00阶段，Benda博士将独立设计、评估和 试行mHealth PRO和决策支持工具，以提高产后患者的知识和自我效能 在SMM和IAPE领域。具体目标是：1）开发和完善设计框架 产后症状报告和决策支持需求的要求; 2）设计和评估 MOMS/MAMA功能原型，通过启发式反馈与专家进行患者可用性测试; 及3）进行一项先导试验，评估MOMS/MAMA的可行性和初步成效， 提高有SMM风险的产后患者的知识和自我效能。为了实现这些目标， 我们组建了一个跨学科的团队，在信息学，护理，公共卫生， 少数民族健康、临床试验以及技术设计和评估。我们的团队也有临床领域 产科/妇科和心理学/精神病学方面的专业知识。我们的提案涉及重要的公共卫生 该组织还致力于解决各种问题（SMM和IAPE），并通过针对受影响最严重的少数群体来减少差异。 考虑到新能力的阵列和以患者为中心的工作的多学科性质， K99/R 00奖是实现候选人设计技术型职业目标的必要步骤 采取措施促进卫生公平。

PROJECT ABSTRACT/SUMMARY Severe maternal morbidity (SMM) rates have risen 120-200% in the United States in the past two decades,1 and experts estimate that 40-60% of these cases are preventable.2,3 Suicide or self-harm related to postpartum psychiatric issues, although typically reported separately from SMM, is the second leading cause of maternal death.4,5 There additional intensive-acute psychiatric events (IAPE) that do not result in death not reflected in statistics of SMM. Improvement initiatives are predominantly hospital-based and rely on women recognizing their own symptoms and seeking care without ample support or education. We hypothesize that we can improve patients’ self-efficacy and decision-making about when to seek care by helping them to self-monitor symptoms and by providing decision support. We propose to develop a mHealth-based, patient-reported outcome (PRO) and decision-support system to help mothers determine when to seek care for warning signs of SMM. Our project focuses on diverse populations facing postpartum disparities, particularly African- American and Spanish-speaking Latina women. The long-term goal is to enable Dr. Benda to leverage this work into an independent research program, which will design, evaluate, and implement technologies to improve health equity. Using the robust resources of Weill Cornell Medical College and external advisors, work in the K99 phase will develop and validate a framework of design requirements for postpartum symptom reporting and decision-support needs. In the R00 phase, Dr. Benda will independently design, evaluate, and pilot a mHealth PRO and decision-support tool to improve knowledge and self-efficacy for postpartum patients in the areas of SMM and IAPE. The specific aims are to: 1) develop and refine a framework of design requirements for postpartum symptom reporting and decision-support needs; 2) design and evaluate a functioning prototype of MOMS/MAMA through heuristic feedback with experts usability testing with patients; and 3) conduct a pilot trial assessing the feasibility and preliminary effectiveness of MOMS/MAMA for improving knowledge and self-efficacy among postpartum patients at risk of SMM. To accomplish these aims, we have assembled an interdisciplinary team with research expertise in informatics, nursing, public health, minority health, clinical trials, and technology design and evaluation. Our team also has clinical domain expertise in obstetrics/gynecology and psychology/psychiatry. Our proposal addresses important public health issues (SMM and IAPE) and seeks to reduce disparities by targeting minority groups most affected by them. Given the array of new competencies and the multidisciplinary nature of the patient-centered work, this K99/R00 award is a necessary step to achieve the candidate’s career goal of designing technology-based interventions to advance health equity.