RP1 _NBEC

非西班牙裔黑人和其他黑人之间持续、巨大和不断增加的死亡率差距的临床证据 沿着有病人调查和个人故事的美国妇女，毫无疑问， 卫生保健系统中的性别和种族主义对不同的孕产妇结果有很大影响。的核心 确定降低孕产妇死亡率的因素是保健提供者和机构的干预措施， 认识到种族主义和偏见的根源。我们的长期目标是使尊重护理实践 标准的整个护理连续性-怀孕前到产后1年-以减少产妇 结果。这项申请的总体目标是， 目的是证明一个多方面的，以证据为基础的干预措施将减少医院在孕产妇 结果。我们的中心假设是，实施多方面培训干预的医院， 将公平纳入所有质量改进工作，并与基于社区的 组织将有更好的孕产妇健康结果比医院谁实施远程 异步内隐偏见训练。我们之前的研究将虐待、歧视和 种族主义在整个照顾连续性的身体和情感伤害黑人母亲。的基本原理 这项研究的基础是，减少不公平和不尊重的待遇可能会提供强有力的 采取多层面公平办法的科学依据有助于缩小差距。我们的研究 策略将是在9家Ochsner医院内进行多医院群集随机对照试验 （每年约1900名工作人员和14000例分娩），以比较交互式多方面干预-内隐偏倚 培训，在所有质量改进中纳入公平原则，建立社区伙伴关系-偏远地区 异步训练单独干预。产妇保健将通过一个与之相匹配的综合结果来衡量。 通过电子健康记录集中收集的ACOG患者安全捆绑建议，以及 医院消费者对医疗保健提供者和系统的常规评估 收集的数据。这将使我们达到以下目的：1）确定多方面的效果 尊重的产科护理干预对医院孕产妇结局和患者满意度差异的影响; 2） 确定多方面尊重产妇护理干预对提供者偏见的影响; 3）检查如何 尊重产妇护理和隐性偏见干预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，通过将现有的解决偏见待遇的方法结合起来， 减少了孕产妇保健结果的差异。

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.