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

项目摘要/摘要：项目2 在美国，几乎每三个新生儿中就有一个涉及剖腹产。在适当的时候进行拯救生命的干预， 剖腹产与重大风险有关，包括严重的产后出血和严重的产妇 发病率(SMM)。与阴道分娩相比，接受剖腹产的妇女患癌症的风险最高 产后出血及出血相关发病率。在过去的30年里，利率的显著差异 对于黑人妇女来说，剖腹产的风险已经上升，差异使她们的发病率从 出血和死亡率。因此，降低剖宫产率对减少产后出血至关重要。 和产后相关的SMM。消除剖宫产分娩的差异需要多方面、多层次的 可大规模部署的干预措施。我们将利用我们的专业知识，实现人口水平 产妇结局的改善(包括出血和剖腹产)和长期的 与患者、社区和公共卫生机构建立协作伙伴关系，以确定和实施 减少剖腹产和出血差异的策略。我们覆盖全州的质量改进网络 借助复杂的实时数据中心，我们将能够支持复杂的股票干预和跟踪 进步。利用我们由218家医院组成的合作网络，覆盖加州99%的新生儿，我们将 实现以下具体目标：(1)使用混合方法确定减少 剖宫产率和剖腹产相关出血率的差异。(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整合到母性平等中 指南，一个推动医院内部公平变革的资源工具包。(三)扩大母亲节的实施范围 在全州范围内努力缩小差距的公平指南。(4)评估《母亲平等指南》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病人级别的数据 包括患者识别的种族和民族，使我们能够衡量多个产妇健康的变化 州、医院、甚至医疗服务提供者层面的结果。与定性方法相结合，这将提供一个 对我们干预措施的有效性进行了特别有力的分析。结果将制定国家路线图，以 有效地将公平纳入大规模质量改进，以解决剖宫产率差异 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.