EnCoRe MOMS: Engaging Communities to Reduce Morbidity from Maternal Sepsis

孕产妇败血症是孕产妇死亡的第二大原因，也是发病率的主要原因，在以下方面是可以预防的 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。 小规模的分娩人群。然而，以证据为基础的干预措施很少。与我们广泛的社区 伙伴关系和社区组织的领导力咨询委员会(CoLab)，安可 母亲们：参与社区以减少母亲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)开发、实施和评估4个社区信息的孕产妇败血症捆绑包 纽约市不同的医院；(目标2)开发算法以优化分娩和分娩前后脓毒症的预测 产后；和(目标3)进行共同设计过程和定性研究，以探索经验、需求、 以及产妇护理连续性、败血症预防和促进产后公平的可感知解决方案。 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： 设计一种综合性产科脓毒症捆绑包，i)应用并优化标准循证 准备、认可、反应、报告和尊重关怀的组成部分2)结合了多学科 产科提供者隐性偏见培训，以及三)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。整理社区层面的数据集，描述健康的社会决定因素 (SDOH)目标3a。(3a.1)改进我们的CoLab和共同设计流程；(3a.2)深入患者个体 与同一地点的社区和医院利益相关者进行访谈(IDI)和焦点小组讨论(FGD) 探讨SDOH在护理可获得性/质量、结果差异和 护理连续性的解决方案。在UH3阶段，我们将参与社区实施我们的母体败血症 关爱模型、分析结果和翻译结果。目标1b。实施我们的综合性产科败血症 使用过程和结果措施目标1c捆绑和评估其有效性。在电子病历中定义图案 提供商对疑似脓毒症的反应，捆绑实施前和捆绑后；分析 提供者的反应差异和结果目标2c。协调患者级别的EHR和邻居级别的SDOH 数据集，并使用机器学习模型分析患者和患者的个人和联合贡献 在PRC样本目标3b内优化脓毒症风险预测的邻里因素。(3b.1)完整 另外三个医院地点的定性患者IDI和利益相关者FGD；(3b.2)共同设计和 综合支持性护理模式，与我们的社区合作伙伴共同领导，CoLab，以及来自其他AIMS的结果， 需要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 严重孕产妇发病率的可预防原因。

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.