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.

该项目将制定和测试以扩大规模为重点的实施方法，以解决与怀孕有关的问题