RP2_Harville

RP2_哈维尔

• 批准号: 10749377
• 负责人: Emily Wheeler Harville
• 金额: $ 86.1万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 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/10749377
• 关键词: Address; Adoption; Age; Area; Birth; Black race; Blood Pressure; Caring; Client satisfaction; Collaborations; Communities; County; Data; Data Collection; Eligibility Determination; Ethnic Origin; Focus Groups; Goals; Health; Health Services Accessibility; Home; Hospitals; Improve Access; Infrastructure; Internet; Intervention; Interview; Leadership; Louisiana; Manuals; Maternal Health; Maternal Health Services; Maternal health equity; Modeling; Monitor; Not Hispanic or Latino; Outcome; Patient Outcomes Assessments; Patients; Persons; Phase; Postpartum Period; Poverty; Pregnancy; Premature Birth; Procedures; Process; Protocols documentation; Provider; Race; Rural; Sampling; Services; Site; Socioeconomic Status; Specialist; Technology; Testing; Training; Underinsured; Underserved Population; Weight; Woman; black women; design; digital; effectiveness/implementation hybrid; electronic health record system; empowerment; experience; geographic disparity; health care availability; high risk; implementation barriers; implementation evaluation; implementation intervention; implementation outcomes; improved; innovation; mortality risk; obstetric care; obstetric services; pregnant; programs; racial disparity; remote health care; rural area; tool

In Louisiana, those living in parishes that lack access to maternal care, referred to as “maternity care deserts” experience a 91% increase in risk of death during pregnancy and up to 1 year postpartum. Black women are already at higher risk independent of their residential status, and counties with larger numbers of non-Hispanic Black women have higher odds of losing all hospital obstetric services. As obstetric care in these largely rural parishes is unlikely, there is a critical need to develop interventions that will improve maternal health care in these areas. The overall objective of this application is to examine the potential of enhanced remote care to improve maternal health. The overall hypothesis is that innovative models of care, based in community priorities and context, can mitigate the lack of high-level services located in these areas. When patients live far from care sites, remote care has obvious advantages, reducing the need for long trips, limiting unnecessary care, and identifying problems earlier. Ochsner’s Connected MOM program (at-home blood pressure and weight monitoring) has been successfully implemented in southern Louisiana and been associated with a reduction in preterm birth. However, Black and rural women were less likely to benefit from the program that white and urban women. The project will be conducted in two phases: In the formative phase (years 1-2), the project goal is to establish community needs, relationships, and infrastructure to conduct a remote care intervention (Connected MOM+) that reflects the community’s leadership and priorities. This will be accomplished by presenting Connected MOM to community groups and determining the service needs, technological challenges, and barriers to implementation of the intervention, via interviews and focus groups. Implementation phase project infrastructure, including protocols, manuals of procedures, data collection tools, provider training, digital infrastructure, and staffing, will then be created. In the implementation phase (years 3- 7), a hybrid effectiveness-implementation stepped-wedge study will be conducted, testing implementation, process, and health outcomes of the enhanced remote care package across 27 parishes in northern Louisiana. Access to care, health, and implementation outcomes (reach/adoption/fidelity) will be examined via the electronic health record system, and patient satisfaction and implementation outcomes (acceptability/appropriateness) assessed in a sample. This project will have an important positive impact by improving the health of, and empowering, a high-risk, underserved population.

在路易斯安那州，那些生活在缺乏孕产妇护理的教区的人被称为“孕产妇护理沙漠” 怀孕期间和产后 1 年内的死亡风险增加 91%。黑人女性是 无论其居住状况如何，以及非西班牙裔人数较多的县，都已经面临较高的风险 黑人女性失去所有医院产科服务的可能性更高。由于这些主要是农村地区的产科护理 教区的可能性不大，迫切需要制定干预措施来改善产妇保健 这些领域。该应用程序的总体目标是检查增强远程护理的潜力 改善孕产妇健康。总体假设是，基于社区的创新护理模式 优先事项和背景，可以缓解这些地区缺乏高水平服务的情况。当患者住得较远时 从护理地点来看，远程护理具有明显的优势，减少了长途旅行的需要，限制了不必要的护理 护理，并及早发现问题。 Ochsner 的 Connected MOM 计划（家庭血压和 体重监测）已在路易斯安那州南部成功实施，并与 减少早产。然而，黑人和农村妇女从该计划中受益的可能性较小 白人和城市女性。该项目将分两个阶段进行： 在形成阶段（第 1-2 年）， 项目目标是建立社区需求、关系和基础设施以进行远程护理 反映社区领导力和优先事项的干预措施（互联 MOM+）。这将是 通过向社区团体展示 Connected MOM 并确定服务需求来完成， 通过访谈和焦点小组讨论实施干预措施的技术挑战和障碍。 实施阶段项目基础设施，包括协议、程序手册、数据收集工具、 然后将创建提供者培训、数字基础设施和人员配置。在实施阶段（第3年- 7) 将进行混合有效性实施阶梯楔形研究，测试实施情况， 路易斯安那州北部 27 个教区的强化远程护理计划的流程和健康结果。 获得护理、健康和实施结果（达到/收养/忠诚度）将通过 电子健康记录系统、患者满意度和实施结果 （可接受性/适当性）在样本中进行评估。该项目将产生重要的积极影响 改善高风险、服务不足人群的健康并增强其能力。