Epidemiology of prehospital obstetric conditions and out-of-hospital deliveries in the US

美国院前产科疾病和院外分娩的流行病学

• 批准号: 10571272
• 负责人: Rebecca E Cash
• 金额: $ 21万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10571272
• 关键词: Address; Admission activity; Area; Birth; Caring; Characteristics; Clinical; Communities; Complex; Country; Data; Data Set; Development; Discipline of obstetrics; Education; Educational Curriculum; Emergency Care; Emergency Medicine; Emergency Situation; Emergency medical service; Emergency response; Emergency treatment; Epidemiology; Event; Frequencies; Future; Goals; Guidelines; Health Personnel; High Risk Woman; High-Risk Pregnancy; Home; Hospitals; Human Resources; Infant Care; Information Systems; Intervention; Intervention Studies; Knowledge; Maternal Age; Maternal Mortality; Maternal and Child Health; Maternal complication; Methodology; Methods; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Neonatal; Neonatal Intensive Care Units; Neonatology; Newborn Infant; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Policy Developments; Postpartum Hemorrhage; Pre-hospital setting; Pre-hospitalization care; Pregnancy; Pregnant Women; Premature Birth; Prevention; Provider; Recommendation; Records; Research; Research Priority; Risk; Sampling; Services; Statistical Data Interpretation; System; Time; Training; Training and Education; Triage; Urban Community; Woman; Work; base; care outcomes; care systems; child services; clinical care; delivery complications; emergency settings; evidence based guidelines; experience; high risk; improved; interest; mortality; natural hypothermia; neonatal death; neonatal resuscitation; obstetric care; obstetric outcomes; out-of-hospital cardiac arrest; patient safety; repository; rural area; safety outcomes; social vulnerability

PROJECT SUMMARY Thousands of unplanned births occur at home in the US each year, and most trigger 911 emergency medical services (EMS) activations (i.e., calls for service). For these high-risk patients, evidence from other countries suggest unplanned out-of-hospital delivery (OHD) is associated with an increased risk of postpartum hemorrhage, neonatal hypothermia, neonatal intensive care unit admission, and maternal and neonatal death. However, little is known about the epidemiology and patient safety of OHD and other obstetric conditions treated by EMS personnel in the US. These major knowledge gaps have resulted in the lack of any evidence-based guidelines for EMS care of an obstetric patient and an ongoing lack of prehospital-specific training in this major area of maternal and child health. The overarching objective of this exploratory R21 project is to better understand the characteristics and clinical care of prehospital obstetric conditions treated by EMS personnel to inform future interventions that will reduce morbidity and mortality and improve prehospital patient care. We will use a national repository of EMS patient care records, the National Emergency Medical Services Information System (NEMSIS), to investigate prehospital care of mothers and their newborn infants. Collectively, from January 2018 to December 2019, NEMSIS includes >50 million EMS patient care records from 47 states and territories and over 10,000 EMS agencies, representing the largest sample of prehospital care records available. In Aim 1, we will describe the patient, community, emergency response, and clinical characteristics of OHDs and other high-risk obstetric conditions treated by EMS personnel, including examining differences by key factors like urbanicity, community-level racial distribution, and maternal age. In Aim 2, we will examine the frequency and prehospital factors associated with patient safety events during OHD and maternal and neonatal resuscitation. In Aim 3, we will use a modified Delphi method with a panel of 10-18 clinical and EMS experts to identify research priorities to improve prehospital care of obstetric conditions. Based on our pilot data, we estimate identifying approximately 7,000 EMS activations for OHD, with over 80% power for the statistical analyses in Aims 1 and 2. The present R21 project will provide a unique opportunity for the first national description of EMS care of obstetric patients in the US and prehospital-specific research priorities to guide research and interventions to improve prehospital patient outcomes and safety. This study directly responds to the NICHD priority to improve treatment of women at high risk for pregnancy-related morbidities and mortality; the Notice of Special Interest in Research on Emergency Medical Services for Children (NOT-HD-19-022); the Notice of Special Interest in Research in the Emergency Setting (NOT-NS-20-005); and the Healthy People 2030 objectives to reduce maternal deaths and severe maternal complications.

项目摘要 每年在美国，成千上万的计划外生出现在美国，大多数触发911紧急医疗 服务（EMS）激活（即服务电话）。对于这些高风险患者，来自其他国家的证据 建议计划外院外交付（OHD）与产后的风险增加有关 出血，新生儿体温过低，新生儿重症监护病房的入院以及母亲和新生儿死亡。 但是，关于OHD的流行病学和患者安全知之甚少 由美国EMS人员在美国。这些主要的知识差距导致缺乏任何基于证据的 EMS护理产科患者的指南以及在这一主要的院前特定培训的持续缺乏 孕产妇和儿童健康领域。该探索性R21项目的总体目标是更好 了解EMS人员治疗的院前产科状况的特征和临床护理 告知将来的干预措施，以降低发病率和死亡率并改善院前患者护理。我们将 使用EMS患者护理记录的国家存储库，国家紧急医疗服务信息 系统（NEMSIS），调查母亲及其新生婴儿的院前护理。共同从 2018年1月至2019年12月，NEMSIS包括来自47个州和 领土和10,000多个EMS机构，是最大的院前护理记录样本。 在AIM 1中，我们将描述OHDS和 EMS人员治疗的其他高风险产科条件，包括通过关键因素检查差异 像城市化，社区水平的种族分布和产妇年龄一样。在AIM 2中，我们将检查频率 以及与OHD以及母体和新生儿期间患者安全事件相关的院前因素 复苏。在AIM 3中，我们将使用一个修改后的Delphi方法，其中包含10-18个临床和EMS专家的面板 确定研究优先级以改善院前护理对产科条件的护理。根据我们的试点数据，我们 估计识别大约7,000个EMS激活的OHD，统计功率超过80％ 目标1和2中的分析。当前的R21项目将为第一个国家提供独特的机会 EMS护理美国产科患者的描述以及院前特定研究的重点 研究和干预措施，以改善院前患者的结果和安全性。这项研究直接回应 NICHD的优先事项是改善对妊娠相关的病态和死亡率高风险的妇女的治疗； 关于儿童紧急医疗服务研究的特殊兴趣通知（NOT-HD-19-022）；这 紧急环境中的研究特殊兴趣通知（NOT-NS-20-005）；和健康的人2030 减少孕产妇死亡和严重孕产妇并发症的目标。