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灵感 患有物质使用障碍(SUD)的人面临着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以证据为基础的、个人-- 集中护理。本研究的目标是开发和评估INSPIRE，这是一种跨专业的干预措施 医疗团队改善对围产期物质使用障碍(SUD)患者的护理 关心。INSPIRE被设想为一种模块化干预，适应个别提供者的需求。会的 包括三个核心模块(关于分娩中SUD的网络研讨会、面对面模拟培训和患者小插曲 使用人工智能技术实时反馈临床同理心技能)。助推器模块将 根据提供者对核心结构(偏见、倦怠、临床同理心)的响应进行交付。在目标1中，我们 将使用严格的定性方法来检查产科护理中的偏见和耻辱 从提供者和患者的角度来看，患有SUD的个人。在AIM 2中，我们将应用这些数据来开发 鼓励干预。与利益相关者顾问委员会合作，我们将调整模拟培训课程，以 并开发其他模块，侧重于临床同理心、偏见和耻辱以及职业倦怠。 使用以人为本的设计原则，我们将在犹他州周围建立设施的模块原型。在……里面 目标3，我们将使用准实验设计评估犹他大学医院的INSPIRE 确定：a)对医疗团队结果的影响，b)对患者结果的影响，以及c)潜在的 可扩展性。我们将在支持分娩的临床专科招募400名医疗团队成员 个人。所有注册提供商都将收到INSPIRE，评估将在基线上进行，2 两个月和六个月。医疗服务提供者的主要结果是偏见，使用医疗条件量表 (MCRS)。我们将使用混合效应线性评估从基线到6个月的MCRS分数的变化 回归模型，用于提供干预前和干预后得分的配对样本比较。 为了评估患者水平的结局，我们将在两个时间段内招募有SUD分娩的患者：前- 干预(n=100)和干预后(n=100)。患者调查将在以下时间之前亲自进行 从分娩和分娩出院，病历数据将在产后6个月内提取。这个 患者的主要结果将是自我报告的以人为本的产妇护理(PCMC)。我们将使用线性 检验基线和终点线之间PCMC得分差异的回归分析，控制潜力 混血儿。我们将应用RE-AIM实施科学框架来评估计划的潜力 放大。在6-7年间，我们将支持Elevate Center在全州范围内传播和实施 鼓舞人心。我们将培训全州临床环境中的设施级冠军，并支持该中心 收集可靠的实施数据，以记录INSPIRE在独特临床中的应用和适应情况 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.