Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk

针对风险最高的产后母亲，改善健康成果和公平

• 批准号: 10266856
• 负责人: Elizabeth A Howell
• 金额: $ 70.95万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10266856
• 关键词: Accident and Emergency department; Acute; Address; Attention; Behavioral; Cardiometabolic Disease; Cardiovascular system; Caring; Case Management; Childbirth; Chronic; Chronic Disease; Clinical; Color; Communities; Complication; Depression screen; Diabetes Mellitus; Educational Intervention; Elderly; Emergency department visit; Evidence based intervention; Gestational Diabetes; Goals; Health; Heart failure; High Risk Woman; Hospitals; Hypertension; Individual; Intervention; Intervention Trial; Latina; Lead; Life; Lung; Maternal Health; Maternal Mortality; Maternal complication; Measures; Medical; Methods; Morbidity - disease rate; Mothers; Neighborhoods; Outcome; Pilot Projects; Plant Roots; Postpartum Period; Pregnancy; Procedures; Pulmonary Edema; Qualitative Methods; Quality of Care; Risk; Risk Factors; Social Environment; Time; Visit; Woman; black women; cardiometabolic risk; care seeking; clinical risk; cohort; design; evidence base; experience; follow-up; health disparity; high risk; hospital readmission; implementation trial; improved; intervention refinement; maternal morbidity; maternal risk; mortality; mortality disparity; postpartum care; postpartum complications; postpartum health; postpartum morbidity; predictive modeling; pregnancy related death; pregnant; prevent; primary outcome; racial and ethnic disparities; research study; risk prediction model; scale up; severe maternal morbidity; sociodemographics

Alarming racial and ethnic disparities in maternal mortality persist in the US. Black women are three to four times more likely to die a pregnancy-related death as compared with White women, and in some regions Latinas are also at increased risk. This disparity is rooted in the fact that Black and Latina women experience elevated maternal health risks throughout the pregnancy-postpartum continuum. Women of color are more likely to begin pregnancy with a chronic health condition such as hypertension or diabetes, experience a complication while pregnant, and to suffer a life-threatening morbidity during delivery. Less recognized is that heightened maternal health risks extend into the postpartum period. Black and Latina women are more likely to experience a postpartum complication, to seek care in the emergency department (ED) after delivery, and have an increased risk of postpartum hospital readmission relative to White women. Growing attention has focused on the postpartum period as an important window to address maternal mortality disparities as half of pregnancy-related deaths occur within one day to one year after delivery and the majority of maternal deaths and a sizable portion severe complications are preventable. We propose a mixed method study to better identify Black and Latina women most at risk for poor outcomes following delivery, the problems they experience, and to adapt an evidence-based intervention that aims to improve quality of postpartum care for high risk women. The aims of our research study, “Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk” are to: 1) Develop a risk a prediction model using sociodemographic, clinical, behavioral, and neighborhood factors to identify high-risk mothers using ED visits and postpartum readmissions as a marker of severe maternal morbidity. 2) Use qualitative methods to adapt and intensify an evidence-based behavioral educational intervention aimed at improving quality of care to reduce severe maternal morbidity as measured by postpartum ED use and hospital readmission, 3) Conduct a pilot RCT utilizing the cohort identified by the risk prediction model in Aim 1 to assess feasibility, acceptability, and target effect size and potential efficacy of the refined intervention to reduce ED visits and postpartum readmissions, and 4) Evaluate the pilot study results and procedures to inform the refinement of the intervention and to prepare for a larger implementation trial of this intervention.

在美国，孕产妇死亡率的种族和民族差异仍然令人震惊。黑人女性是三到四岁 与白色妇女相比， 拉丁裔也面临更大的风险。这种差异根源于黑人和拉丁裔妇女的经历， 在整个怀孕-产后期间，孕产妇健康风险增加。有色人种的女性 可能开始怀孕时患有慢性健康状况，如高血压或糖尿病， 怀孕期间的并发症，并在分娩期间遭受危及生命的疾病。不太为人所知的是， 产妇健康风险的增加一直延续到产后时期。黑人和拉丁裔女性更有可能 经历产后并发症，在分娩后到急诊科（艾德）寻求护理，以及 与白色女性相比，产后再次入院的风险增加。越来越多的关注， 将产后期作为解决孕产妇死亡率差距的重要窗口， 与怀孕有关的死亡发生在分娩后一天至一年内， 相当一部分严重并发症是可以预防的。我们提出了一种混合方法研究，以更好地 确定黑人和拉丁裔妇女最有可能在分娩后出现不良结局， 经验，并采取循证干预措施，旨在提高产后护理质量， 高危女性。我们研究的目的，“通过有针对性地 "高危产后母亲”是：1）利用社会人口学， 临床，行为和邻里因素，以确定高风险的母亲使用艾德访问和产后 再次入院作为严重孕产妇发病率的标志。2)使用定性方法调整和加强 以证据为基础的行为教育干预，旨在提高护理质量， 通过产后艾德使用和再入院来衡量产妇发病率，3）进行试点RCT 利用目标1中风险预测模型确定的队列，评估可行性、可接受性和目标 减少艾德就诊和产后再入院的精细干预的效应量和潜在功效， 和4）评估试点研究结果和程序，为干预措施的完善提供信息， 准备对这一干预措施进行更大规模的实施试验。