Living Healthy for Moms

项目2：项目总结/摘要 大多数可预防的孕产妇死亡发生在产时和产后初期， 未被发现/治疗不足的精神健康（MH）状况的并发症（例如，自杀，过量）和 心血管（CV）事件。在纽约市，黑人的孕产妇死亡率是黑人的8-12倍。 白色的父母。然而，大多数以社区为基础的计划， 在这一人群中，已经狭隘地集中在基本服务上（例如，母乳喂养、社会支持）， 注重循证护理。满足老年人生理、心理和社会健康需求的整体干预措施 关键的PP过渡和从基于创伤和“风险”的方法转向基于力量和赋权的方法 是迫切需要的。许多医院、社区和政府障碍阻碍了广泛采用和扩展 助产士提供的护理，目前还不知道如何促进者，资产和资源可以提高护理的连续性 和社区医院的联系，以支持分娩个人在不同的网站在纽约市。导乐的影响- 在病人和卫生系统层面的主导干预措施尚待严格评估。协同 加勒比妇女健康协会和北方曼哈顿围产期伙伴关系，我们将解决 通过在三个互补的环境中实施和评估母亲健康生活（LHMoms）， 和人口（布鲁克林、皇后区和北方曼哈顿）。LHMoms是一种新型的综合护理干预措施 集中关注出院前开始的护理连续性和社区与医疗保健的联系 在出院后的前7天（PD）和产后6个月内，作为关键窗口， 预防长期身心健康后遗症，同时解决终身健康的关键决定因素 风险我们开发了几种创新的、基于证据的干预措施，包括在线教育。 授权计划（使用我们开发的患者激活学习系统平台），以建立患者自我， 从医院开始倡导;在关键的头7天，由Doula领导的卫生紧急情况检测方案 PD;以及创伤知情的Doula提供的认知行为电话干预，以解决PP抑郁症 和心血管疾病的风险。我们提出了一个严格的，混合的方法 LHMoms的研究，以解决三个具体目标。在目标1中，我们将测试LHMoms与注意力的有效性 在三家医院的450名随机分娩个体中进行的混合1型实施试验的对照 在布鲁克林皇后区和北方曼哈顿。这将包括改进和调整干预措施， 网站，以最大限度地提高护理质量，建设能力的导乐提供LHMoms，并评估有效性， 降低PP抑郁，改善CV健康，创造更好的生活质量。在目标2中，我们将分析 LHMoms对PP医疗保健利用率和满意度的影响。在目标3中，我们将研究 LHMoms在三个地点的干预过程和结果。该项目将推进总体目标 的NY-CHAMP，以优化PP的结果，为历史上处于不利地位的分娩个人。

PROJECT 2: PROJECT SUMMARY/ABSTRACT Most preventable maternal deaths occur in the intrapartum and immediate postpartum (PP) periods, as do complications from undetected/undertreated mental health (MH) conditions (e.g., suicide, overdose) and cardiovascular (CV) events. In New York City (NYC), maternal deaths are 8–12 times higher for Black than for White birthing parents. However, most community-based programs addressing the health of birthing individuals in this population have been narrowly focused on basic services (e.g., breastfeeding, social support), with limited focus on evidence-based care. Holistic interventions addressing physical, mental, and social health needs in the critical PP transition and moving from trauma- and “risk”-based to a strength- and empowerment-based approach are urgently needed. Many hospital, community, and governmental barriers preclude broad adoption and scaling of doula-delivered care, and it is not known how facilitators, assets, and resources can improve care continuity and community-hospital linkages to support birthing individuals at diverse sites across NYC. The impact of doula- led interventions at patient- and health-system levels have yet to be rigorously evaluated. In collaboration with the Caribbean Women's Health Association and the Northern Manhattan Perinatal Partnership, we will address these gaps by implementing and evaluating Living Healthy for Moms (LHMoms) in three complementary settings and populations (Brooklyn, Queens, and Northern Manhattan). LHMoms is a novel integrated care intervention that focuses intensively on care continuity and community-to-healthcare linkages that starts prior to discharge and during the first 7 days post-discharge (PD) and extends into six months post-partum, as critical windows to prevent long-term physical and mental health sequelae, while also addressing key determinants of lifelong health risk. We have developed several innovative, evidence-based interventions, including an online education empowerment program (using a Patient Activated Learning System platform we developed) to build patient self- advocacy beginning in-hospital; a doula-led health emergency detection program during the critical first 7 days PD; and a trauma-informed doula-delivered cognitive behavioral phone intervention to address PP depression and cardiovascular risks for the critical six months following delivery. We propose a rigorous, mixed-methods study of LHMoms to address three specific aims. In Aim 1, we will test the effectiveness of LHMoms vs. attention control in a Hybrid Type 1 Implementation Trial with 450 randomized birthing individuals at three hospital sites in Brooklyn, Queens, and Northern Manhattan. This will include refining and tailoring the intervention to each site to maximize care quality, building capacity for doulas to deliver LHMoms, and assessing effectiveness in lowering PP depression, improving CV health, and creating better quality of life. In Aim 2, we will analyze the effects of LHMoms on PP healthcare utilization and satisfaction. In Aim 3, we will examine the implementation process and outcomes of the LHMoms intervention at the three sites. This project will advance the overall goals of NY-CHAMP to optimize PP outcomes for historically disadvantaged birthing individuals.