Project INSPIRE – (Interprofessional Simulation Program for Clinical Resilience and Empathy) for healthcare teams caring for birthing individuals with substance use disorder in Utah

项目摘要/摘要：项目2启发

PROJECT SUMMARY / ABSTRACT: PROJECT 2 INSPIRE Individuals with substance use disorder (SUD) face a higher risk of severe maternal morbidity and mortality. Provider bias and stigma contribute to these outcomes by attenuating the provision of evidence-based, person- centered care. The goal of this study is to develop and evaluate INSPIRE, an intervention for interprofessional healthcare teams to improve care for individuals with substance use disorder (SUD) during their peri-delivery care. INSPIRE is envisioned as a modular intervention, adaptive to the needs of individual providers. It will include three core modules (a webinar on SUD in birth, an in-person simulation training, and patient vignettes with real-time feedback on clinical empathy skills using artificial intelligence technology). Booster modules will be delivered based on provider response across core constructs (bias, burnout, clinical empathy). In AIM 1, we will use rigorous qualitative methods to examine bias and stigma in obstetric care for pregnant and birthing individuals with SUD from provider and patient perspectives. In AIM 2, we will apply these data to develop the INSPIRE intervention. Working with a stakeholder advisory board, we will adapt simulation training curricula for the SUD context, and develop additional modules focused on clinical empathy, bias and stigma, and burnout. Using human centered design principles, we will prototype modules with facilities around the state of Utah. In AIM 3, we will evaluate INSPIRE at the University of Utah hospital using a quasi-experimental design to determine: a) impact on healthcare team outcomes, b) impact on patient outcomes, and c) potential for scalability. We will enroll 400 healthcare team members across clinical specialties that support birthing individuals. All enrolled providers will receive INSPIRE, and assessments will be conducted at baseline, 2 months, and 6 months. The primary outcome for providers is bias, using the Medical Conditions Regard Scale (MCRS). We will assess change in MCRS scores from baseline to 6 months using a mixed effects linear regression model, specified to provide a paired-sample comparison between pre- and post-intervention scores. To assess patient level outcomes, we will enroll patients with SUD giving birth in two time periods: pre- intervention (n=100) and post-intervention (n=100). Patient surveys will be conducted in person, prior to discharge from labor and delivery, and medical record data will be abstracted up to 6 months postpartum. The primary outcome for patients will be self-reported Person-Centered Maternity Care (PCMC). We will use linear regression to examine differences in PCMC scores between baseline and endline, controlling for potential confounders. We will apply the RE-AIM implementation science framework to assess potential for program scale-up. In Years 6-7, we will support the ELEVATE Center in statewide dissemination and implementation of INSPIRE. We will train facility-level champions in clinical settings across the state and support the Center to collect robust implementation data to document the uptake and adaptations of INSPIRE across unique clinical environments.