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.

该项目将开发并测试针对妊娠相关的针对大规模的实施方法 以及相关的发病率和死亡率（PRAMM）分布。以前的努力表明，使用医院 - 集中的母校安全束是成功减少PRAMM的成功努力的重要组成部分。但是，总体而言 这些努力的产科护理质量改善了，而没有对差异产生任何影响。与以前的努力不同， 拟议的项目将实施：（1）关注PRAMM差异； （2） 专注于社区护理（即门诊和其他社区环境医院外提供的护理） 和护理环境之间的协调。鉴于美国有83％的与孕妇有关的和孕妇相关的 死亡在怀孕或产后发生（而不是分娩时期），门诊和 社区努力至关重要。捆绑包（要实施的循证实践）是由 全国孕产妇卫生社区护理倡议（AIM-CCI）的创新联盟，包括 “产后安全和保健的社区护理”和“对母校心理健康的社区护理”， “慢性病”和“亲密伴侣暴力”捆绑。所有捆绑包目标PRAMM分布。 •拟议项目的目标1将分析2个县的捆绑实施经验，以开发一个 与利益相关者日期合作，县范围范围的规模限制捆绑 创建和手动化扩大实施干预措施。 •AIM 2将评估扩大实施干预的有效性和成本效益 在12个密歇根州县的阶梯楔形设计中，总人口近600万人。 PRAMM结果（个人级别）将从已有的全州链接数据集中提取。这 这些分析的样本将包括在观察到的12个县的所有医疗补助人员 在项目期间，怀孕，出生时和产后1年（约151,920次出生，包括〜49,110 非裔美国人和/或西班牙裔母亲的出生。实施结果（提供者级）包括 扩展（渗透，覆盖，控制权以及大规模的干预效果）和维持 （维持对核心要素的保真度，健康益处以及随着时间的推移提供核心要素的能力）。 该项目具有创新性，因为它：（1）是测试方法的第一个受控实施试验 实施质量改进捆绑包：（a）专门针对PRAMM差异； （b）专注于 社区护理； （2）提高了扩大科学（这是我们知道测试规模的第一项研究 - 提高或维持实施方法来解决孕产妇的发病率/死亡率分布）； （3） 致力于改善许多（与单个）卫生系统的服务。该项目很重要，因为我们 需要大规模吸引孕妇，扩大规模是实施科学的一个知识。