Patient Centered Community and Clinical Approaches to Reduce Racial Disparities at Birth by Preventing Anemia

以患者为中心的社区和临床方法通过预防贫血来减少出生时的种族差异

• 批准号: 10748637
• 负责人: Deirdre Lyell
• 金额: $ 52.07万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748637
• 关键词: Accountability; Admission activity; Adopted; Adoption; Affect; Anemia; Awareness; Birth; Black race; California; Cesarean section; Childbirth; Childhood; Clinic; Clinical; Communities; Dedications; Discipline of obstetrics; Disparity; Education; Ensure; Equity; Erythrocytes; Evaluation; Evidence based practice; Exclusion; Feedback; Frontline worker; Goals; Guidelines; Health system; Hematology; Hemoglobin; Hemorrhage; Hispanic; Hospitals; Household; Impairment; Incidence; Income; Inequity; Infant; Infection; Inherited; Institution; Iron; Iron deficiency anemia; Latina; Latino; Latinx; Leadership; Link; Maternal Mortality; Measures; Methodology; Methods; Modeling; Modification; Native Americans; Oregon; Outcome; Oxygen; Pathway interactions; Patient Care; Patient Education; Patient-Centered Care; Patients; Persons; Pharmaceutical Preparations; Populations at Risk; Postpartum Hemorrhage; Pre-Eclampsia; Predisposition; Pregnancy; Premature Birth; Prenatal care; Prevention; Prevention approach; Provider; Public Health; Qualitative Research; Quality of Care; Race; Reporting; Research; Resources; Risk; Severities; Sickle Cell Anemia; Site; Source; Standardization; Structural Racism; Structure; System; Testing; Time; United States; Uterus; Washington; Work; adverse maternal outcomes; antenatal; clinical care; community center; data centers; dietary; disparity reduction; ethnic disparity; evidence base; experience; health disparity; implementation framework; implementation strategy; improved; innovation; iron deficiency; iron supplementation; maternal risk; novel; patient oriented; pregnant; prevent; racial disparity; screening; severe maternal morbidity; tool; trend; usability; webinar

Project Summary/Abstract: Project 1 Iron deficiency anemia (IDA) affects up to one-third of people during pregnancy, with Black and Hispanic/Latina people experiencing the highest rates. IDA is a condition of too little iron in the body, resulting in too few healthy red blood cells, which puts pregnant people at risk for postpartum hemorrhage (PPH; excessive bleeding after childbirth) and related severe maternal morbidity (SMM). IDA is preventable, but current approaches to prevention and treatment are not working. The incidence of IDA during pregnancy is increasing, the disparities are worsening, and patient perspectives are lacking. Rates of IDA at birth admission, the time of greatest maternal risk, are up to 3-4x higher among Black pregnant people compared to White pregnant people and 1.5-2x higher among Latinx pregnant people. The goal of this project is to increase hemoglobin (i.e., resolve anemia) at birth admission for all pregnant people, thereby reducing the racial/ethnic disparities in IDA and reducing anemia-related SMM from PPH. The objective of this project is to create a novel Anemia Prevention Toolkit (i.e., a set of patient- and community-centered guidelines and implementation strategies) and then implement and disseminate it at scale using collaborative quality improvement methods. The rationale underlying this work is that both clinicians, represented by the Clinical Collaborative Leadership Group, and community partners and people with lived experience of IDA, represented by the Anemia Community Leadership Group, desire the education and guidance of such a toolkit and are dedicated to working together to create, optimize, and implement it. We will achieve our goal by pursuing the following three Specific Aims: 1) develop an Anemia Prevention Toolkit that aligns evidence-based practice with patient- centered care, incorporating patients’ lived experience, community assets, and clinical/hospital workflows; 2) optimize the Toolkit to increase hemoglobin at birth admission by piloting it at 8 hospitals, and examine its acceptability and practicality; and 3) implement and disseminate the modified Toolkit across a network of more than 300 hospitals in CA, OR, and WA to reduce anemia and SMM from PPH. To pursue these aims, we will utilize a rigorous implementation science framework that combines patient-centered community perspectives with structured, evidence-based clinical care and education for anemia in pregnancy. Guided by the Pathways to Racial and Ethnic Disparities in SMM and Mortality Model, the project’s outcomes will prioritize patient and community experiences and input. Clinical and health system stakeholders and frontline staff will work together in alignment with the Public Health Critical Race Praxis, employing an iterative methodology to ensure attentiveness to equity throughout the project. This innovative approach holds the research team accountable to the patients and communities impacted by the significant problem of IDA during pregnancy—establishing community partners as project co-leads, adopting methods that require ongoing check-in with the community, and recognizing bias and structural racism as a factor that contributes to health disparities in IDA.

项目概要/摘要：项目1 缺铁性贫血（IDA）影响多达三分之一的人在怀孕期间，黑人和西班牙裔/拉丁裔 人们经历了最高的利率。IDA是一种体内铁含量过少的情况，导致体内铁含量过少。 健康的红细胞，这使孕妇有产后出血的风险（PPH;过量 产后出血）和相关的严重孕产妇发病率（SMM）。IDA是可以预防的，但目前 预防和治疗方法不起作用。妊娠期缺铁性贫血的发病率正在增加， 差距正在扩大，缺乏病人的观点。出生时IDA的比率， 最大的孕产妇风险，黑人孕妇比白色孕妇高3- 4倍 在拉丁裔孕妇中高出1.5- 2倍。这个项目的目标是增加血红蛋白 (i.e.,解决贫血症），从而减少 IDA和减少PPH引起的贫血相关SMM。该项目的目标是创造一种新的贫血症 预防工具包（即，一套以病人和社区为中心的指导方针和实施战略） 然后使用协作质量改进方法大规模实施和传播。的 这项工作的基本原理是，由临床协作领导代表的两名临床医生 小组、社区合作伙伴和有IDA生活经验的人， 社区领导小组，希望教育和指导这样一个工具包，并致力于 我们将通过以下三个方面来实现我们的目标： 具体目标：1）开发贫血预防工具包，使循证实践与患者- 集中式护理，结合患者的生活经验、社区资产和临床/医院工作流程; 2） 优化工具包，通过在8家医院进行试点，在入院时增加血红蛋白，并检查其 可接受性和实用性;以及3）在一个由更多人组成的网络中实施和传播经修订的工具包。 加州、俄勒冈州和华盛顿州的300多家医院，以减少PPH引起的贫血和SMM。为了实现这些目标，我们将 利用严格的实施科学框架，结合以患者为中心的社区观点 通过结构化的、循证的临床护理和妊娠贫血教育。以道为导， 对于SMM和死亡率模型中的种族和民族差异，该项目的结果将优先考虑患者和 社区经验和投入。临床和卫生系统利益相关者和一线工作人员将共同努力 与公共卫生关键种族实践保持一致，采用迭代方法，以确保 在整个项目中注重公平。这种创新的方法使研究团队负责 在怀孕期间受到IDA重大问题影响的患者和社区， 社区合作伙伴作为项目的共同领导者，采用需要与社区进行持续检查的方法， 并认识到偏见和结构性种族主义是造成国际开发协会健康差距的一个因素。