Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

斯坦福大学 PRIHSM：预防与出血相关的严重孕产妇发病率的不平等

• 批准号: 10748636
• 负责人: SUZAN L CARMICHAEL
• 金额: $ 212万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748636
• 关键词: Address; Admission activity; Affect; Anemia; Asian; Asian population; Attention; Birth; Black Populations; Black race; California; Caring; Centers of Research Excellence; Cesarean section; Clinical; Collaborations; Communities; Complex; Diagnosis; Dimensions; Discipline; Discipline of obstetrics; Disparity; Emotional; Environment; Equity; Ethnic Origin; Evaluation; Goals; Healthcare; Hemorrhage; High Prevalence; Hospitalization; Hospitals; Incidence; Individual; Inequity; Intervention; Iron deficiency anemia; Latinx; Latinx population; Leadership; Life Cycle Stages; Link; Location; Maternal Health; Maternal Mortality; Maternal health equity; Mental Health; Methods; Morbidity - disease rate; Mothers; Native Americans; Outcome; Patients; Persons; Play; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Prevalence; Prevention; Prevention strategy; Provider; Race; Research; Research Infrastructure; Rest; Risk; Risk Factors; Role; Science; Standardization; Training; Translating; Universities; Work; antenatal; community involvement; disparity elimination; disparity reduction; effective therapy; ethnic disparity; experience; health equity; high risk; improved; innovation; intrapartum; marginalized population; mortality; multidisciplinary; post-traumatic stress; post-traumatic symptoms; postpartum health; prevent; prospective; racial disparity; severe maternal morbidity; social; social structure; training opportunity; treatment strategy; underserved area

Project Summary: Overall Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) and disproportionately affects socially marginalized groups. We propose to create a Maternal Health Research Center of Excellence at Stanford University called PRIHSM (PReventing Inequities in Hemorrhage-related Severe Maternal morbidity). The goals of PRIHSM are to reduce PPH and associated SMM by reducing and addressing disparities in important precursors to PPH-related SMM and mortality: cesarean birth and iron deficiency anemia (IDA). The problem of maternal IDA is vastly under-appreciated yet it affects approximately 16% of pregnancies in the U.S.; rates are 3-4x higher among Black people and 1.5-2x higher among Latinx people compared to the rest of the population. This translates to higher rates of PPH-related SMM. We propose that by effectively addressing antenatal IDA and these disparities, we can reduce PPH-related SMM. Additionally, almost 1 in 3 U.S. births are by cesarean delivery, rates vary 10-fold across hospitals, and Black and Asian individuals have the highest prevalence of cesarean section among low-risk pregnancies. While cesarean section can be a lifesaving intervention when appropriate, it is associated with significant risks that include PPH. We propose that enhanced birth equity and reduced variability in obstetric management are important strategies in addressing disparities in cesarean-linked PPH and reducing PPH-related SMM. Thus, our Aims are to: Aim 1 (Project 1). Reduce antenatal IDA by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit, which will standardize the evaluation, diagnosis, and treatment of IDA and reduce the prevalence of IDA and racial/ethnic disparities in IDA at birth admission and PPH-associated SMM. Aim 2 (Project 2). Reduce disparities in rates of primary cesarean birth and cesarean-linked PPH by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. Our work will involve community-university partnerships focused on improving maternal health equity and be driven by perspectives of patients, providers, and healthcare leadership. Our work will provide training opportunities to build research and clinical expertise relevant to PPH, especially among individuals who represent diverse perspectives and experiences within academic and community-based settings, and underserved areas. We propose a bold yet achievable agenda that will affect a sustainable decline in PPH-related mortality and morbidity and disparities.

项目概要：总体 产后出血（PPH）是孕产妇死亡和严重孕产妇发病率（SMM）的主要原因，对社会边缘化群体的影响尤为严重。我们建议在斯坦福大学建立一个产妇健康卓越研究中心，名为PRIHSM（预防与出血相关的严重产妇发病率的不平等）。PRIHSM的目标是通过减少和解决PPH相关SMM和死亡率的重要前体（剖宫产和缺铁性贫血（IDA））的差异来减少PPH和相关SMM。母亲IDA的问题被大大低估，但它影响了美国约16%的怀孕;与其他人口相比，黑人的发病率高出3- 4倍，拉丁美洲人高出1.5- 2倍。这意味着与BPH相关的SMM发生率更高。我们建议，通过有效地解决产前IDA和这些差距，我们可以减少产后PH相关的SMM。此外，美国近三分之一的新生儿是剖腹产，各医院的剖腹产率相差10倍，黑人和亚洲人在低风险妊娠中的剖腹产率最高。虽然剖宫产在适当的时候可以是一种挽救生命的干预措施，但它与包括PPH在内的重大风险相关。我们建议，提高出生公平性和减少产科管理的变异性是解决剖腹产相关PPH和减少PPH相关SMM的差异的重要战略。因此，我们的目标是：目标1（项目1）。通过制定、实施和传播患者知情的贫血预防工具包来减少产前IDA，该工具包将标准化IDA的评估、诊断和治疗，并减少IDA的患病率和出生入院时IDA的种族/民族差异以及产后PH相关的SMM。目标2（项目2）。通过进行混合方法研究以了解这些结果中医院水平差异的驱动因素，并实施患者知情的孕产妇公平指南，减少初次剖宫产率和剖宫产相关PPH率的差异。我们的工作将涉及社区大学合作伙伴关系，重点是改善孕产妇健康公平，并由患者，提供者和医疗保健领导的观点驱动。我们的工作将提供培训机会，以建立与PPH相关的研究和临床专业知识，特别是在学术和社区环境中代表不同观点和经验的个人以及服务不足的地区。我们提出了一个大胆但可实现的议程，将影响到与产后出血有关的死亡率和发病率以及差距的可持续下降。