EnCoRe MOMS: Engaging Communities to Reduce Morbidity from Maternal Sepsis

EnCoRe MOMS：让社区参与降低孕产妇败血症的发病率

• 批准号: 10611196
• 负责人: Alexander M Friedman
• 金额: $ 95.8万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2023-09-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10611196
• 关键词: Accountability; Accounting; Address; Advocacy; Affect; Algorithms; Biometry; Birth; Black race; Caring; Cessation of life; Clinical; Communication; Communities; Community Health Aides; Community Hospitals; Continuity of Patient Care; Data Set; Databases; Disadvantaged; Discipline of Nursing; Discipline of obstetrics; Education; Effectiveness; Electronic Health Record; Ensure; Ethnic Origin; Evidence based intervention; Focus Groups; Health Services Accessibility; Health Services Research; Health system; Hospitals; Individual; Informatics; Inpatients; Intervention; Interview; Joints; Knowledge; Lead; Leadership; Maternal Health; Maternal Mortality; Maternal-fetal medicine; Modeling; Morbidity - disease rate; Neighborhoods; Outcome; Outcome Measure; Patients; Pattern; Perinatal; Perinatal Epidemiology; Persons; Phase; Policies; Postpartum Period; Poverty; Pregnancy; Prevention; Process; Process Measure; Protocols documentation; Provider; Quality of Care; Race; Readiness; Reporting; Research; Research Infrastructure; Resources; Risk; Safety; Sampling; Sepsis; Services; Site; Social Environment; Social Sciences; Standardization; Structural Racism; Supportive care; System; Time; Training; Translating; Use Effectiveness; Variant; adverse maternal outcomes; base; clinical risk; community based participatory research; community center; community engaged research; community engagement; community partnership; design; disability; ethnic diversity; evidence base; experience; health care availability; health equity; health inequalities; health training; high risk; implementation framework; implementation process; implementation science; implicit bias; individual patient; inpatient service; machine learning model; maternal morbidity; maternal outcome; maternal risk; mortality; multidisciplinary; novel; patient oriented; postpartum morbidity; prevent; racial and ethnic; racial diversity; response; risk prediction; screening; severe maternal morbidity; social; social epidemiology; social health determinants; socioeconomic disadvantage; standard of care; support network; underserved community

Maternal sepsis is the second leading cause of maternal death, major cause of morbidity, and preventable in most cases. Labor, birth, and postpartum are periods of increased sepsis risk, particularly for racial and ethnic minoritized birthing people. Yet few evidence-based interventions exist. With our extensive community partnerships and community organized leadership advisory board (CoLAB), EnCoRe MoMS: Engaging Communities to Reduce Morbidity from Maternal Sepsis will address three highly related specific aims: (Aim 1) Develop, implement, and evaluate a community-informed maternal sepsis bundle in 4 diverse NYC hospitals; (Aim 2) Develop algorithms to optimize prediction of sepsis around delivery and postpartum; and (Aim 3) Conduct a co-design process and qualitative study to explore the experiences, needs, and perceived solutions for maternal care continuity, sepsis prevention, and promotion of equity in postpartum. In the UG3 phase we will establish robust community engagement and research infrastructures to: Aim 1a: Design a comprehensive obstetric sepsis bundle that i) applies and optimizes standard evidence-based components of readiness, recognition, response, reporting, and respectful care ii) incorporates multidisciplinary obstetric provider implicit bias training, and iii) integrates social determinants of health (SDOH) training and screening Aim 2a. Create a rich electronic health records (EHR) database from the Perinatal Research Consortium (PRC). Aim 2b. Collate neighborhood-level datasets characterizing social determinants of health (SDOH) Aim 3a. (3a.1) Refine our CoLAB and co-design process; (3a.2) Conduct in-depth individual patient interviews (IDIs) and focus group discussions (FGDs) with community and hospital stakeholders from one site to explore the lived experiences and perspectives of SDOH on care access/quality, outcome disparities, and solutions for care continuity. In the UH3 phase, we will engage community to implement our maternal sepsis care model, analyze results, and translate findings. Aim 1b. Implement our comprehensive obstetric sepsis bundle and evaluate its effectiveness using process and outcome measures Aim 1c. Define patterns in EHR of provider response to suspected sepsis, pre- vs post-bundle implementation; analyze associations between provider response variation and outcomes Aim 2c. Harmonize patient-level EHR and neighborhood-level SDOH datasets and use machine learning models to analyze the individual and joint contributions of patient and neighborhood factors to optimize sepsis risk prediction within the PRC sample Aim 3b. (3b.1) Complete qualitative patient IDIs and stakeholder FGDs for the three additional hospital sites; (3b.2) Co-design an integrative supportive care model, with our community partner co-lead, CoLAB, and results from other aims, that entails maternal sepsis community engagement, care linkages, education, services, and policy efforts. Our resulting model can be scaled to hospitals and communities with lesser resources and applied to other preventable causes of severe maternal morbidity.

孕产妇脓毒症是孕产妇死亡的第二大原因，也是发病的主要原因，并且是可以预防的 大多数情况下。分娩、分娩和产后是败血症风险增加的时期，特别是对于种族和民族而言 少数民族生育人群。然而，基于证据的干预措施却很少。凭借我们广泛的社区 伙伴关系和社区组织的领导咨询委员会 (CoLAB)、EnCoRe MoMS：让社区参与降低孕产妇败血症的发病率将解决三个高度相关的问题 具体目标：（目标 1）在 4 年内制定、实施和评估社区知情的孕产妇脓毒症捆绑包 纽约市多家医院； （目标 2）开发算法来优化分娩周围脓毒症的预测 产后； （目标 3）进行协同设计过程和定性研究，以探索经验、需求、 以及孕产妇护理连续性、败血症预防和促进产后公平的已知解决方案。 在 UG3 阶段，我们将建立强大的社区参与和研究基础设施，以： 目标 1a： 设计一个全面的产科败血症包，i) 应用和优化基于证据的标准 准备、认可、响应、报告和尊重护理的组成部分 ii) 包含多学科 产科提供者隐性偏见培训，以及 iii) 整合健康的社会决定因素 (SDOH) 培训和 筛选目标 2a。从围产期研究创建丰富的电子健康记录 (EHR) 数据库 财团（中国）。目标 2b。整理表征健康社会决定因素的社区级数据集 (SDOH) 目标 3a。 (3a.1) 完善我们的 CoLAB 和协同设计流程； (3a.2) 深入个体患者 在同一地点与社区和医院利益相关者进行访谈 (IDI) 和焦点小组讨论 (FGD) 探索 SDOH 关于护理获取/质量、结果差异的生活经验和观点，以及 护理连续性的解决方案。在 UH3 阶段，我们将让社区参与实施我们的孕产妇败血症 护理模型、分析结果并转化结果。目标 1b。实施我们全面的产科败血症 使用过程和结果测量目标 1c 进行捆绑并评估其有效性。定义 EHR 中的模式 提供商对疑似脓毒症的反应、捆绑实施前与捆绑后实施后的情况；分析之间的关联 提供者反应变化和结果目标 2c。协调患者级 EHR 和社区级 SDOH 数据集并使用机器学习模型来分析患者和患者的个人和联合贡献 优化 PRC 样本中脓毒症风险预测的邻里因素目标 3b。 (3b.1) 完成 另外三个医院地点的定性患者 IDI 和利益相关者 FGD； (3b.2) 共同设计 与我们的社区合作伙伴 CoLAB 共同领导的综合支持性护理模式以及其他目标的结果， 需要孕产妇败血症社区参与、护理联系、教育、服务和政策努力。我们的 由此产生的模型可以扩展到资源较少的医院和社区，并应用于其他领域 严重孕产妇发病的可预防原因。