RP1 _NBEC

RP1_NBEC

• 批准号: 10749376
• 负责人: Susan Perez
• 金额: $ 59.19万
• 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/10749376
• 关键词: Address; Adoption; American College of Obstetricians and Gynecologists; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Client satisfaction; Clinical; Conceptions; Continuity of Patient Care; Country; Data; Developed Countries; Discrimination; Disparate; Disparity; Educational Intervention; Electronic Health Record; Emotional; Equity; Ethnic Origin; Evidence based intervention; Goals; Harm Reduction; Health Personnel; Healthcare Systems; Hospitals; Incidence; Individual; Inequity; Institution; Intervention; Interview; Link; Maternal Health; Maternal Mortality; Maternal health equity; Measures; Minority Women; Mothers; Not Hispanic or Latino; Outcome; Patients; Postpartum Period; Provider; Public Health; Race; Randomized, Controlled Trials; Recommendation; Recording of previous events; Reporting; Research; Surveys; Training; Uncertainty; United States; Woman; Work; care systems; clinically relevant; community intervention; community organizations; community partnership; comorbidity; disparity reduction; ethnic minority; evidence base; experience; health assessment; health care settings; implementation intervention; implicit bias; improved; maltreatment; maternal outcome; mortality; multi-component intervention; outcome disparities; patient safety; racial bias; racial minority; racism; satisfaction

Clinical evidence of persistent, large, and increasing mortality gaps between Non-Hispanic Black and other women in the United States, along with patient surveys and personal stories leave no doubt that implicit bias and racism in the health care system contribute significantly to disparate maternal outcomes. Central to identifying the factors to reduce maternal mortality are interventions for healthcare providers and institutions to recognize the root causes of racism and bias. Our long-term goal is to make respectful care practices the standard across the care continuum—pre-conception to 1-year postpartum—to reduce disparities in maternal outcomes. The overall objective for this application, which is the next step toward attainment in our long-term goal, is to demonstrate a multifaceted, evidence-based intervention will reduce hospital disparities in maternal outcomes. Our central hypothesis is that hospitals that implement the multifaceted intervention of training, incorporating equity in all quality improvement efforts, and partnership building with community-based organizations will have better maternal health outcomes than hospitals who have implemented remote asynchronous implicit bias training alone. Our previous studies connect mistreatment, discrimination, and racism across the care continuum to physical and emotional harm to Black mothers. The rationale that underlies the proposed research is that reducing inequitable and disrespectful treatment is likely to offer strong scientific rationale for taking a multifaceted approach to equity work to reduce disparities. Our research strategy will be to conduct a multi-hospital cluster-randomized controlled trial within 9 Ochsner hospitals (~1900 staff and 14000 deliveries per year) to compare an interactive multifaceted intervention—implicit bias training, incorporating equity in all quality improvement, and community partnership building— to a remote asynchronous training alone intervention. Maternal health will be measured by a composite outcome matched to ACOG patient safety bundle recommendations, collected centrally through electronic health records, and patient satisfaction by Hospital Consumer Assessment of Healthcare Providers and Systems routinely collected data. This will enable us to achieve the following Aims: 1) Determine the effect of a multifaceted respectful maternity care intervention on hospital maternal outcome and patient satisfaction disparities; 2) Determine the effect of a multifaceted respectful maternity care intervention on provider bias; 3) Examine how a respectful maternity care and implicit bias intervention among impacts patient and hospital staff satisfaction. These results are expected to have an important positive impact because they will provide strong evidence- based proof of principle that, by bringing together existing approaches for addressing biased treatment and care, maternal outcome disparities are reduced.

临床证据表明非西班牙裔黑人与其他种族之间的死亡率差距持续存在、巨大且不断扩大 对美国女性的调查以及患者调查和个人故事无疑表明隐性偏见 医疗保健系统中的种族主义在很大程度上导致了孕产妇结局的差异。中央至 确定降低孕产妇死亡率的因素是医疗保健提供者和机构采取的干预措施 认识种族主义和偏见的根源。我们的长期目标是使尊重的护理实践成为 整个护理过程（从受孕前到产后 1 年）的标准，以减少孕产妇之间的差异 结果。此应用程序的总体目标，这是我们长期目标的下一步 目标是证明多方面的、基于证据的干预措施将减少孕产妇的医院差异 结果。我们的中心假设是，实施多方面培训干预的医院， 将公平性纳入所有质量改进工作，并与社区建立伙伴关系 与实施远程服务的医院相比，组织将获得更好的孕产妇保健结果 仅异步隐式偏差训练。我们之前的研究将虐待、歧视和 整个护理过程中的种族主义对黑人母亲的身体和情感造成伤害。理由是 拟议研究的基础是减少不公平和不尊重的待遇可能会提供强有力的 采取多方面方法开展公平工作以减少差距的科学依据。我们的研究 策略将是在 9 家 Ochsner 医院内进行多医院集群随机对照试验 （每年约 1900 名员工和 14000 次分娩）比较交互式多方面干预措施——隐性偏见 培训、将公平纳入所有质量改进以及社区伙伴关系建设——到远程 单独干预异步训练。孕产妇健康将通过匹配的综合结果来衡量 通过电子健康记录集中收集的 ACOG 患者安全包建议，以及 通过医院消费者定期对医疗保健提供者和系统进行评估来评估患者满意度 收集的数据。这将使我们能够实现以下目标： 1）确定多方面的效果 对医院产妇结果和患者满意度差异进行尊重的产妇护理干预； 2） 确定多方面尊重的产妇护理干预措施对提供者偏见的影响； 3）检查如何 尊重的产妇护理和隐性偏见干预会影响患者和医院工作人员的满意度。 这些结果预计将产生重要的积极影响，因为它们将提供强有力的证据—— 基于原则的证明，通过将解决偏见待遇的现有方法结合起来， 照护、孕产妇结局差异缩小。