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

项目总结/摘要：项目2 INSPIRE 物质使用障碍（SUD）患者面临更高的严重孕产妇发病率和死亡率风险。 提供者的偏见和耻辱通过削弱提供基于证据的、个人的、 中心护理本研究的目的是开发和评估INSPIRE，一种跨专业的干预措施， 医疗保健团队，以改善对物质使用障碍（SUD）患者在围产期的护理 在乎根据设想，INSPIRE是一种模块化干预措施，可适应各个提供者的需要。它将 包括三个核心模块（关于出生时SUD的网络研讨会、现场模拟培训和患者简介 使用人工智能技术对临床共情技能进行实时反馈）。助推器模块将 基于提供者对核心结构（偏见，倦怠，临床同理心）的反应进行交付。在AIM 1中，我们 将使用严格的定性方法来检查偏见和耻辱的产科护理怀孕和分娩 从供应商和患者的角度来看，SUD患者。在AIM 2中，我们将应用这些数据开发 INSPIRE干预。与利益相关者咨询委员会合作，我们将调整模拟培训课程， SUD的背景下，并开发额外的模块集中在临床同理心，偏见和耻辱，和倦怠。 使用以人为本的设计原则，我们将原型模块与设施周围的犹他州。在 AIM 3，我们将在犹他州大学医院使用准实验设计评估INSPIRE， 确定：a）对医疗团队结局的影响，B）对患者结局的影响，以及c） 可伸缩性我们将招募400名支持分娩的临床专业医疗团队成员 个体所有入组的提供者将收到INSPIRE，并将在基线时进行评估，2 一个月，六个月。提供者的主要结果是偏见，使用医疗条件关注量表 （MCRS）。我们将使用混合效应线性模型评估MCRS评分从基线至6个月的变化 回归模型，指定用于提供干预前和干预后评分之间的配对样本比较。 为了评估患者水平的结局，我们将在两个时间段招募SUD分娩的患者： 干预（n = 100）和干预后（n = 100）。患者调查将在 从分娩和分娩中出院，并提取产后6个月的病历数据。的 患者的主要结局将是自我报告的以人为中心的产妇护理（PCMC）。我们将使用线性 回归以检查基线和终点之间PCMC评分的差异，控制潜在的 混杂因素。我们将应用RE-AIM实施科学框架来评估项目的潜力。 按比例放大。在6 - 7年，我们将支持ELEVATE中心在全州范围内传播和实施 灵感。我们将在全州的临床环境中培训设施级冠军，并支持该中心 收集可靠的实施数据，以记录INSPIRE在独特的临床 环境.

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.