Medical Information Service via mobile Telephone (m-MIST TM) Provider Support to Improve Pregnancy Outcomes

项目总结 全世界几乎所有的孕产妇和围产儿死亡都发生在低收入国家。访问延迟 接受适当质量的妊娠护理，特别是在分娩和分娩期间，是导致 这些结果。减少不良妊娠结局是当前和高度全球的优先事项。伊利诺伊大学 阿拉巴马州伯明翰分校(UAB)的母婴医学和新生儿小组是主要的转诊对象 在服务不足的阿拉巴马州，为高危孕妇和新生儿提供服务。通过UAB的高度 有价值、忙碌和开创性的24/7全天候免费电话医疗信息服务(MISTTM)、及时和 通常，农村的孕妇护理提供者可以获得救命的护理地点咨询和指导 妇女和新生儿。虽然这样的提供者支持服务现在是 在美国，它们的执行情况和对该执行情况的评估往往无法在#年得到。 孕产妇和围产儿结局最差的LICs。LIC中移动电话拥有量的快速增长 为适应、实施和评估创新的、可能挽救生命的产品提供了巨大的机会 MISTTM等干预措施。移动平台可以帮助缓解结构性障碍并增强 通过为偏远地区的提供商提供临床支持来满足患者的医疗访问需求 医疗紧急情况--同时也在资源有限的情况下加强当地的护理系统。因此， 本研究的目的是适应和评估基于移动电话的MIST(MMIST)的实施情况 改善LIC中的孕产妇和新生儿结局。拟议的mMIST干预将从我们的 在产妇死亡率位居第9位的喀麦隆实施的UAB持续经验 也是世界上围产儿死亡率最高的国家之一。我们提出了三个具体目标：1)适应和 为为孕妇提供医疗保健的外围设备提供商开发全天候移动健康支持系统 2)在喀麦隆西北部的一个卫生区测试mMIST的可行性和可接受性；以及 3)使用阶梯式楔形整群随机试验设计评估全范围试验的有效性 实施mMIST以减少孕产妇和围产儿死亡以及严重孕产妇和新生儿死亡 喀麦隆西北部19个区(群)的疾病，每年有65,000例分娩。参与性的 利益攸关方和有代表性的特别工作组参与的方法将为制定和交付 干预行动。三个框架将为这项研究提供信息，世卫组织护理质量模式，适应-ITT 干预适应和实施科学的探索、准备、实施、 维持(EPIS)模型。其他功能包括计划通过让 政府和移动服务提供商，并重视移动健康能力建设在这方面的严谨 研究性学习。如果证明有效，扩大mMIST干预将改善孕产妇和 在类似的LIC环境中的新生儿结局。

PROJECT SUMMARY Almost all maternal and perinatal deaths worldwide are in low-income countries (LICs). Delays in accessing and receiving appropriate quality pregnancy care, particularly during labor and delivery, is a major reason for these outcomes. Reducing adverse pregnancy outcomes is a current and high global priority. The University of Alabama at Birmingham's (UAB) maternal and fetal medicine and neonatology groups are the primary referral services for high-risk pregnancies and newborns statewide in underserved Alabama. Through UAB's highly valued, busy and pioneering toll-free 24/7 Medical Information Service via Telephone (MISTTM), timely, and often life-saving point-of-care consultation and guidance is available to rural providers caring for pregnant women and newborns. Although such provider support services are now part of standard-of-care in the United States, their implementation and assessment of that implementation are often unavailable in LICs with the worst maternal and perinatal outcomes. The rapid rise in mobile phone ownership in LICs provides a tremendous opportunity to adapt, implement, and evaluate innovative, potentially life-saving interventions such as MISTTM. The mobile platform can help mitigate structural barriers and enhance healthcare access needs of the patient by providing clinical support for remotely-located providers facing medical emergencies -- while also enhancing local care systems in resource-constrained settings. Thus, the purpose of this study is to adapt and evaluate the implementation of mobile-phone based MIST (mMIST) to improve maternal and newborn outcomes in a LIC. The proposed mMIST intervention will be adapted from our ongoing experience at UAB and implemented in Cameroon, which has the 9th highest maternal mortality ratio and one of the highest rates of perinatal mortality in the world. We propose three Specific Aims: 1) Adapt and develop a 24/7 mHealth support system for peripheral providers who provide healthcare to pregnant women and newborns; 2) Test mMIST's feasibility and acceptability in one health district in northwest Cameroon, and 3) Evaluate the effectiveness - using a stepped wedge cluster randomized trial design - of full-scale implementation of mMIST in reducing maternal and perinatal deaths, and serious maternal and newborn morbidities in 19 districts (clusters) of northwest Cameroon with 65,000 deliveries per year. A participatory approach involving stakeholders and a representative task force will inform the development and delivery of the intervention. Three frameworks will inform this study, WHO Model for Quality of Care, ADAPT-ITT for intervention adaptation, and the implementation science Exploration, Preparation, Implementation, Sustainment (EPIS) model. Additional features include plans to ensure sustainability by engaging the government and mobile service providers, and attention to m-health capacity building within this rigorous research study. If demonstrated effective, scaling-up the mMIST intervention will improve maternal and newborn outcomes across similar LIC settings.