Scale-up implementation approaches to ending pregnancy related and associated morbidity and mortality (PRAMM) disparities

扩大实施方法以结束与妊娠相关的发病率和死亡率 (PRAMM) 差异

• 批准号: 10755551
• 负责人: Jaye Clement
• 金额: $ 73.01万
• 依托单位: HENRY FORD HEALTH + MICHIGAN STATE UNIVERSITY HEALTH SCIENCES
• 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/10755551
• 关键词: Address; African American; Awareness; Birth; Birth Records; Caring; Charge; Chronic; Communities; Community Health; Community Healthcare; County; Data; Data Set; Death Records; Disparity; Effectiveness of Interventions; Elements; Equity; Evidence based practice; Face; Goals; Health; Health Benefit; Health system; Hispanic; Hospitals; Individual; Intervention; Investments; Lead; Link; Maintenance; Manuals; Maternal Health; Maternal Mortality; Medicaid; Mental Health; Michigan; Morbidity - disease rate; Mothers; Not Hispanic or Latino; Outcome; Outpatients; Penetration; Persons; Policies; Population; Postpartum Period; Pregnancy; Provider; Racial Equity; Research; Safety; Sampling; Science; Services; Surveys; Testing; Time; United States National Institutes of Health; Women' s Health; Work; community center; community setting; cost; cost effectiveness; design; disparities in morbidity; effectiveness evaluation; evidence based guidelines; experience; health equity; implementation cost; implementation intervention; implementation outcomes; implementation science; implementation trial; improved; innovation; intimate partner violence; maternal morbidity; maternal safety; meetings; mortality; mortality disparity; obstetric care; postpartum care; pregnancy associated death; pregnant; programs; scale up; severe maternal morbidity

This project will develop and test a scale-up focused implementation approach for addressing pregnancy-related and -associated morbidity and mortality (PRAMM) disparities. Previous efforts have shown that use of hospital- focused maternal safety bundles are an important part of successful efforts to reduce PRAMM. However, overall quality of obstetric care improved in these efforts without any effect on disparities. Thus, unlike previous efforts, the proposed project will implement quality improvement bundles that: (1) focus on PRAMM disparities; and (2) focus on community care (i.e., care provided outside the hospital in outpatient and other community settings) and coordination among care settings. Given that 83% of U.S. pregnancy-related and pregnancy-associated deaths occur during pregnancy or postpartum (rather than around the time of delivery), outpatient and community efforts are vital. Bundles (the evidence-based practices to be implemented) are developed by the national Alliance for Innovation on Maternal Health Community Care Initiative (AIM-CCI), and include “Community care for postpartum safety and wellness,” and “Community care for maternal mental health,” “Chronic conditions,” and “Intimate partner violence” bundles. All bundles target PRAMM disparities. • Aim 1 of the proposed project will analyze bundle implementation experiences in 2 counties to develop a county-wide scale-up focused implementation approach for the bundles in partnership with stakeholders date to create and manualize a scale-up implementation intervention. • Aim 2 will evaluate the effectiveness and cost-effectiveness of the scale-up implementation intervention using a stepped wedge design in 12 Michigan counties with a total population of nearly 6 million people. PRAMM outcomes (individual level) will be extracted from a pre-existing statewide linked dataset. The sample for these analyses will include all Medicaid insured individuals in the 12 counties observed during pregnancy, at birth, and up to 1 year postpartum during the project period (~151,920 births, including ~49,110 births to African American and/or Hispanic mothers). Implementation outcomes (provider-level) include scale-up (penetration, reach, control for delivery, and intervention effectiveness at scale) and sustainment (maintenance of fidelity to core elements, health benefits, and capacity to deliver core elements over time). This project is innovative because it: (1) is the first controlled implementation trial to test approaches to implementing quality improvement bundles that: (a) specifically target PRAMM disparities; and (b) focus on community care; (2) advances the science of scale-up (it is the first study of which we are aware to test scale- up or sustainment implementation approaches to addressing maternal morbidity/mortality disparities); and (3) works to improve services across many (vs. a single) health systems. The project is significant because we need to reach pregnant people at scale, and scale-up is an understudied aspect of implementation science.

该项目将开发和测试一种以扩大为重点的实施方法，以解决与怀孕有关的问题 与之相关的发病率和死亡率(PRAMM)差异。之前的努力表明，使用医院- 有重点的孕产妇安全捆绑是成功减少PRAMM努力的重要组成部分。然而，总体而言 在这些努力中，产科护理质量有所改善，但对差异没有任何影响。因此，与之前的努力不同， 拟议的项目将实施质量改进捆绑：(1)关注PRAMM差异；和(2) 侧重于社区护理(即在医院外门诊和其他社区环境中提供的护理) 以及护理环境之间的协调。鉴于83%的美国人与怀孕有关和与怀孕有关 死亡发生在怀孕或产后(而不是分娩前后)、门诊和 社区的努力是至关重要的。捆绑包(将实施的循证实践)由 国家孕产妇保健社区护理创新联盟倡议(AIM-CCI)，包括 “社区关爱产后安全与健康”和“社区关爱产妇心理健康”， “慢性病”和“亲密伴侣暴力”捆绑在一起。所有捆绑包都针对PRAMM差异。 ·拟议项目的目标1将分析两个县的捆绑实施经验，以制定 与利益攸关方合作，在全县范围内重点推广捆绑包的实施方法 创建并手动执行纵向扩展实施干预。 ·目标2将评估扩大执行干预措施的效力和成本效益 在密歇根州12个县使用阶梯式楔形设计，总人口近600万。 PRAMM结果(个人水平)将从预先存在的全州范围的关联数据集中提取。这个 这些分析的样本将包括期间观察的12个县的所有医疗补助参保个人 在项目期间怀孕、出生时和产后最多一年(约151,920名新生儿，包括约49,110名新生儿 非裔美国人和/或西班牙裔母亲的生育)。实施成果(提供者级别)包括 扩大规模(渗透率、覆盖范围、交付控制和干预效果)和维持 (保持对核心要素的忠诚度、健康效益和随着时间推移交付核心要素的能力)。 该项目具有创新性，因为它：(1)是测试以下方法的第一个受控实施试验 实施质量改进捆绑：(A)具体针对PRAMM差异；和(B)侧重于 社区护理；(2)推动了扩大规模的科学(这是我们意识到的第一项测试规模的研究- 解决孕产妇发病率/死亡率差距的上行或持续执行办法)；和(3) 致力于改善多个(而不是单一)医疗系统的服务。这个项目意义重大，因为我们 需要大规模接触孕妇，而扩大规模是实施科学研究不足的一个方面。