Maternal Health Multilevel Intervention/s for Racial Equity (MIRACLE) Center

具体目标（总体）。拟议的促进孕产妇保健公平的多层次干预措施的目标 （奇迹）中心的目标是减少与妊娠有关和与妊娠有关的孕产妇发病率和死亡率 （PRAMM）通过创新和文化相关的非裔美国人，西班牙裔和农村人口的差异， evant社区合作的有效性和实施研究。该中心将满足以下需求： 多层次的，以社区为中心的，以公平为重点的干预措施的开发和测试，重点是scala， 解决PRAMM差异的能力和可持续性。拟议的奇迹中心具有创新性，因为它： (1)测试在多个卫生系统中实施的补充性、多层次的妊娠至产后干预措施， 项目和设置;（2）解决和措施广泛的PRAMM条件（包括非严重莫尔， 与怀孕有关的死亡率，这些死亡率不太经常测量），以及严重的孕产妇死亡率。 发病率（SMM）和妊娠相关死亡率;（3）分析每个项目内的主要影响和协同效应 跨项目的影响，针对不同的水平和差距的来源;（4）使用全州范围内的联系， icaid数据集（索赔，生命记录，筛选数据），以评估共同的结果，允许数据协调， 跨项目和与全国其他中心的一体化;以及（5）关注未充分研究的实施 扩大规模和维持的科学概念。该中心是重要的，因为它：（1）开发和测试新的 在多个层面和多个系统中解决不平等决定因素的方法，（2）测试这些方法， 在密歇根州的20个县实施以人口公平为重点的干预措施，覆盖人口超过700万; (3)使用公平合作的中心结构，与学术和卫生系统或社区PI的 每个组件的中心和。所有这些特点都增强了拟议工作的效用和影响。通过 三个R 01范围的项目，实施和测试多层次的干预措施，以及社区伙伴关系， 培训中心将实现以下目标：（1）评估有效性，成本效益- 创新和文化相关的多层次干预措施的重要性、实施和全人口影响 通过三个R 01范围的项目消除PRAMM差异;（2）生成和扩展创新的AP- 消除PRAMM差异的方法和伙伴关系;（3）最大限度地提高可扩展性，可持续性，文化关系， （4）提高研究、实践和政策能力 消除PRAMM差异。该中心植根于文化知情的多学科研究 社区，长期的社区，健康和政策合作伙伴参与中心的所有阶段 工作，并与黑人和西班牙裔符合医疗补助条件的母亲及其家庭在城市和农村的伙伴关系 设置.在学术和卫生机构的实物财政支持下，该中心将产生可扩展的 以可持续的方式挽救孕产妇生命，结束可预防和不平等的孕产妇痛苦。

SPECIFIC AIMS (Overall). The goal of the proposed Multilevel Interventions to Advance Maternal Health Equity (MIRACLE) Center is to reduce pregnancy-related and pregnancy-associated maternal morbidity and mortality (PRAMM) disparities in African American, Hispanic, and rural populations through innovative and culturally rel- evant community-partnered effectiveness and implementation research. This Center will address the need for multilevel, community-centered, equity-focused interventions developed and tested with an emphasis on scala- bility and sustainment to address PRAMM disparities. The proposed MIRACLE Center is innovative because it: (1) tests complementary, multilevel pregnancy-to-postpartum interventions operating across multiple health sys- tems and settings; (2) addresses and measures a wide range of PRAMM conditions (including non-severe mor- bidity and pregnancy-associated mortality, which are less commonly measured), as well as severe maternal morbidity (SMM) and pregnancy-related mortality; (3) analyzes main effects within each project and synergistic effects across projects, which target different levels and sources of disparities; (4) uses a statewide linked Med- icaid dataset (claims, vital records, screening data) to evaluate common outcomes, allowing for data harmoni- zation across projects and with other Centers nationally; and (5) focuses on the understudied implementation science concepts of scale-up and sustainment. The Center is significant because it: (1) develops and tests novel approaches to addressing determinants of inequities at multiple levels and in multiple systems, (2) tests these population-level equity-focused interventions in 20 Michigan counties, covering a population of >7 million; and (3) uses an equitably partnered Center structure, with academic and health system or community PIs of the Center and of each component. All these features enhance utility and impact of the proposed work. Through three R01-scope projects implementing and testing multilevel interventions, and Community Partnership and Training Components the Center will accomplish the following Aims: (1) Evaluate effectiveness, cost-effective- ness, implementation, and population-wide impact of innovative and culturally relevant multilevel interventions to eliminate PRAMM disparities through three R01-scope projects; (2) Generate and scale innovative ap- proaches & partnerships for eliminating PRAMM disparities; (3) Maximize scalability, sustainability, cultural rel- evance, and broad dissemination of identified approaches; (4) Increase research, practice, and policy capacity for eliminating PRAMM disparities. This Center is rooted in a culturally informed multi-disciplinary Research Community with involvement of longstanding community, health, and policy partners in all phases of the Center’s work, and partnership with Black and Hispanic Medicaid-eligible mothers and their families in urban and rural settings. With in-kind financial support from academic and health institutions, the Center will generate scalable and sustainable approaches for saving maternal lives and ending preventable and unequal maternal suffering.