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.

孕产妇败血症是孕产妇死亡，发病率的主要原因的第二大原因，并且可以预防 大多数情况。劳动，出生和产后是败血症风险增加的时期，特别是种族和种族 少量的分娩人。然而，很少有基于证据的干预措施。与我们广泛的社区 伙伴关系和社区有组织的领导顾问委员会（COLAB），Encore 妈妈：吸引社区降低孕产妇败血症的发病率将解决三个高度相关的 具体目的：（目标1）在4中开发，实施和评估一个社区知情的母体败血症捆绑包 多元化的纽约医院； （目标2）开发算法，以优化交付周围的败血症预测 产后； （目标3）进行共同设计的过程和定性研究，以探索经验，需求， 以及可感知的解决产后孕产妇护理连续性，预防败血症和促进平等的解决方案。 在UG3阶段，我们将建立强大的社区参与和研究基础设施，以：AIM 1A： 设计一个全面的产科败血症捆绑包，i）应用并优化标准循证 准备，认可，响应，报告和尊重护理的组成部分ii）合并多学科 产科提供者的隐性偏见培训，iii）整合健康的社会决定因素（SDOH）培训和 筛选目标2A。从围产期研究中创建丰富的电子健康记录（EHR）数据库 财团（PRC）。目标2B。整理邻里级别的数据集，表征了健康的社会决定因素 （SDOH）AIM 3A。 （3A.1）完善我们的Colab和共同设计过程； （3A.2）进行深入的个人患者 访谈（IDI）和焦点小组讨论（FGD）与一个网站的社区和医院利益相关者 探索SDOH关于护理访问/质量，结果差异和的生活经验和观点 护理连续性的解决方案。在UH3阶段，我们将聘请社区实施我们的母亲败血症 护理模型，分析结果并翻译发现。目标1B。实施我们全面的产科败血症 捆绑并使用过程和结果度量AIM 1C来评估其有效性。在EHR中定义模式 提供者对可疑败血症的反应，前与捆绑后实施；分析之间的关联 提供者响应变化和结果目标2C。协调患者级EHR和邻里级别的SDOH 数据集并使用机器学习模型来分析患者的个人和共同贡献 在中国样本AIM 3B中优化败血症风险预测的邻里因素。 （3b.1）完成 定性患者IDI和利益相关者FGD，用于另外三个医院现场； （3b.2）共同设计an 与我们的社区合作伙伴共同领导者，COLAB以及其他目标的结果，综合支持护理模型， 需要孕妇败血症社区的参与，护理联系，教育，服务和政策工作。我们的 最终的模型可以缩放到资源较低的医院和社区，并应用于其他 可预防的原因是严重的孕产妇发病率。