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扩大规模的重点实施方法，以解决与怀孕相关的问题 和相关的发病率和死亡率（PRAMM）的差异。以前的研究表明，使用医院- 有针对性的孕产妇安全包是成功减少孕产妇死亡率的重要组成部分。但总体来看 在这些努力中，产科护理质量得到了提高，但对差距没有产生任何影响。因此，与以前的努力不同， 拟议的项目将实施质量改进包：（1）关注PRAMM差异;（2） 关注社区护理（即，在医院外门诊和其他社区环境中提供的护理） 和护理机构之间的协调。鉴于83%的美国妊娠相关和妊娠相关 死亡发生在怀孕期间或产后（而不是分娩前后），门诊和 社区的努力至关重要。Bundles（将实施的循证实践）由 国家产妇保健社区护理倡议创新联盟（AIM-CCI），包括 “社区关心产后安全和健康”和“社区关心产妇心理健康”， “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2个县的捆绑实施经验， 与利益攸关方合作，在全州范围内推广有重点的捆绑包实施方法 制定并实施扩大实施规模的干预措施。 ·目标2将评价扩大实施干预措施的有效性和成本效益 在密歇根州的12个县使用阶梯式楔形设计，总人口近600万人。 PRAMM结果（个人层面）将从预先存在的全州链接数据集中提取。的 这些分析的样本将包括12个县的所有医疗补助投保人， 在项目期间，怀孕、分娩和产后1年（约151 920例分娩，包括约49 110例 非裔美国人和/或西班牙裔母亲）。执行成果（提供者一级）包括 扩大规模（渗透、到达、控制投放和大规模干预的有效性）和维持 （保持对核心要素的忠实性、健康益处以及随着时间推移提供核心要素的能力）。 这个项目是创新的，因为它：（1）是第一个控制实施试验，以测试方法， 实施质量改进捆绑包：（a）专门针对PRAMM差异;（B）重点关注 社区护理;（2）推进规模扩大的科学（这是我们所知道的第一项测试规模的研究， 解决孕产妇发病率/死亡率差距的升级或维持执行办法）;以及（3） 致力于改善多个（而不是单一）卫生系统的服务。该项目意义重大，因为我们 需要大规模接触孕妇，而扩大规模是实施科学的一个未充分研究的方面。