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

项目概要/摘要：项目2 在美国，近三分之一的分娩涉及剖腹产。在适当的时候进行救生干预， 剖宫产与严重的风险相关，包括严重的产后出血和严重的产妇死亡。 发病率（SMM）。与阴道分娩相比，接受剖腹产的妇女发生以下风险最高： 产后出血和与产后出血相关的发病率。在过去的30年里， 剖腹产的黑人妇女，差距，提高他们的发病风险， 出血和死亡率。因此，降低剖宫产率对于减少产后出血至关重要 和产后相关的SMM。消除剖宫产差异需要多方面、多层次的 可以大规模部署的干预措施。我们将利用我们的专业知识， 改善产妇结局（包括出血和剖宫产）和长期 与患者、社区和公共卫生机构建立合作伙伴关系， 减少剖宫产和出血差异的策略。我们的全国质量改进网络 拥有先进的实时数据中心，将使我们能够支持复杂的股票干预和跟踪 改进.利用我们218家医院的合作网络，覆盖加州99%的分娩，我们将 实现以下具体目标：（1）使用混合方法的方法，以确定战略，以减少 剖腹产率和剖腹产相关流产率的差异。(2)将患者的声音集中在 验证和持续管理行动工具和资源，这些工具和资源将被纳入孕产妇公平 指南，一个资源工具包，以推动医院内部的公平变化。(3)扩大孕产妇保健服务的实施 在全州范围内努力减少不平等的公平指南。(4)评估《产妇公平指南》的有效性 工具/资源和实施战略。我们收集所有加州出生的实时患者数据 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状况的变化， 结果在国家，医院，甚至供应商的水平。结合定性方法，这将提供一个 特别是对我们干预措施的有效性进行了强有力的分析。结果将建立国家路线图， 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 可能适用于产科护理其他方面的分娩。

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.