RP2_Harville

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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.