Equity in Obstetrics: Reducing disparities in rates of cesarean birth and cesarean-linked hemorrhages

产科公平：减少剖宫产率和剖宫产相关出血率的差异

• 批准号: 10748638
• 负责人: Elliott K Main
• 金额: $ 55.44万
• 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/10748638
• 关键词: Address; Birth; Black Populations; California; Caring; Cesarean section; Clinical; Collection; Communities; Community Health; Community of Practice; Complement; Complex; Data; Data Set; Discipline of obstetrics; Disparity; Equity; Ethnic Origin; Evaluation; Hemorrhage; Hospitals; Individual; Inequity; Institution; Intervention; Interview; Language; Life; Link; Maternal Health; Measures; Methods; Morbidity - disease rate; Outcome; Outpatients; Patients; Performance; Persons; Population; Postpartum Hemorrhage; Postpartum Period; Process; Provider; Public Health; Qualitative Methods; Quality of Care; Race; Reporting; Research; Resources; Risk; Structure; Surveys; System; Time; Translating; United States; Vaginal delivery procedure; Validation; Voice; Woman; Work; black women; clinical practice; cultural equity; data centers; disparity elimination; disparity reduction; effectiveness analysis; effectiveness evaluation; experience; high risk; implementation strategy; improved; insight; maternal outcome; microaggression; mortality; novel; obstetric care; patient oriented; payment; people of color; postpartum morbidity; prevent; prospective; racism; response; severe maternal morbidity; tool; web site

Project Summary/Abstract: Project 2 Almost 1 in 3 births in the United States involves cesarean delivery. A lifesaving intervention when appropriate, cesarean is associated with significant risks that include severe postpartum hemorrhage and severe maternal morbidity (SMM). Compared to vaginal delivery, women undergoing cesarean delivery incur the highest risk of postpartum hemorrhage and hemorrhage-related morbidity. In the last 30 years, significant disparities in rates of cesarean birth have developed for Black women, disparities that elevate their risks of morbidity from hemorrhage and mortality. Reducing cesarean rates is therefore essential for reducing postpartum hemorrhage and postpartum-related SMM. Eliminating disparities in cesarean delivery requires multifaceted, multilevel interventions that can be deployed at scale. We will build on our expertise in achieving population-level improvements in maternal outcomes (including hemorrhage and cesarean delivery) and long-standing collaborative partnerships with patients, communities, and public health agencies to identify and implement strategies to reduce disparities in cesarean birth and hemorrhage. Our state-wide quality improvement network with a sophisticated real-time data center will enable us to support complex equity interventions and track improvement. Capitalizing on our collaborative network of 218 hospitals covering 99% of births in CA, we will realize the following Specific Aims: (1) Use mixed method approaches to identify strategies to reduce disparities in rates of cesarean birth and cesarean-associated hemorrhages. (2) Center patient voices in the validation and continuous curation of action tools and resources that will be integrated into a Maternal Equity Guide, a toolkit of resources to drive equity change within hospitals. (3) Expand implementation of the Maternal Equity Guide in state-wide efforts to reduce disparities. (4) Assess effectiveness of the Maternal Equity Guide tools/resources and implementation strategies. We collect real-time patient-level data for all California births including patient-identified race and ethnicity allowing us to measure changes in multiple maternal health outcomes at state, hospital, and even provider levels. Combined with qualitative methods, this will provide a particularly robust analysis of effectiveness of our interventions. Results will establish a national roadmap for effectively integrating equity into large-scale quality improvement to address disparities in rates of cesarean births with potential application to other aspects of obstetric care.

项目摘要/摘要：项目 2 在美国，近三分之一的分娩涉及剖腹产。适当时采取挽救生命的干预措施， 剖腹产与重大风险相关，包括严重的产后出血和严重的孕产妇风险。 发病率（SMM）。与阴道分娩相比，接受剖腹产的妇女发生以下情况的风险最高 产后出血和出血相关的发病率。过去30年，利率差异显着 黑人妇女剖腹产的比例有所提高，这种差异增加了她们的发病风险 出血和死亡。因此，降低剖宫产率对于减少产后出血至关重要 以及产后相关的SMM。消除剖宫产的差异需要多方面、多层次的努力 可以大规模部署的干预措施。我们将利用我们的专业知识来实现​​人口水平 产妇结局的改善（包括出血和剖腹产）和长期存在的 与患者、社区和公共卫生机构建立合作伙伴关系，确定并实施 减少剖宫产和出血差异的策略。我们的全州质量改进网络 拥有先进的实时数据中心将使我们能够支持复杂的股权干预并跟踪 改进。利用我们由 218 家医院组成的合作网络，覆盖加利福尼亚州 99% 的新生儿，我们将 实现以下具体目标： (1) 使用混合方法来确定减少风险的策略 剖宫产率和剖宫产相关出血率存在差异。 （2）集中患者的声音 验证和持续策划将纳入孕产妇权益的行动工具和资源 指南，一个推动医院内部公平变革的资源工具包。 （三）扩大孕产妇实施范围 全州范围内减少不平等的公平指南。 (4) 评估孕产妇公平指南的有效性 工具/资源和实施策略。我们收集所有加州新生儿的实时患者水平数据 包括患者确定的种族和民族，使我们能够衡量多种孕产妇健康的变化 州、医院甚至医疗服务提供者层面的结果。结合定性方法，这将提供 对我们干预措施的有效性进行特别稳健的分析。结果将制定国家路线图 有效地将公平纳入大规模的质量改进，以解决剖宫产率的差异 分娩可能应用于产科护理的其他方面。