High reach, multi-level digital intervention for Pregnancy-Related and -Associated Morbidity and Mortality (PRAMM) Disparities

美国的妊娠相关和相关发病率和死亡率（PRAMM）远高于美国。 任何其他高收入国家，特别是在农村地区和非西班牙裔（NH）黑人生育人群中。 技术通过提供筛选、定制的数字内容， 和现场援助的联系。数字方法还提供了巨大的可扩展性和潜力， 长期优化。最后，需要足够灵活且易于使用的技术， 该项目还可以通过直接内容创建来支持深度社区输入。该研究建立了 基于PI Ondersma项目开发的现有应用程序（妊娠检查），该应用程序已与 整个密歇根州的产前服务，提供普遍的数字筛查健康风险，一个简短的 动机干预和转介服务。该项目将建立一个怀孕检查- PRAMM（PC-PRAMM）通过两种方式扩展妊娠检查：（1）添加元素以解决关键问题 PRAMM风险在四个不同层面（个人，支持系统，供应商和社区）的决定因素， 进一步优化，以满足黑人孕妇和居住在服务不足的农村地区的人的需求; 和（2）为怀孕的参与者提供立即和安全的“实时聊天”文本访问社区健康 能为当地服务提供温暖的工作人员。PC-PRAMM的开发将采用创新的 社区合作的方法来共同创建应用程序内容。PC-PRAMM将针对已知可预防的 在整个怀孕期间和产后第一年的四个水平的PRAMM的决定因素。我们的第一个具体 目的是与怀孕和产后的人（包括有色人种和来自 农村地区），医疗保健提供者，家庭成员和研究人员开发PC-PRAMM，包括 为提供实时聊天帮助和促进服务参与的CHW提供的手册。第二个具体 目的是评估PC-PRAMM的影响，使用随机分组设计，在10个地理和 密歇根州人口统计学上多样化的产前护理诊所（N = 500名接受医疗补助的参与者 并在妊娠少于20周时登记）。我们将衡量PRAMM风险因素指数的变化 被PC-PRAMM直接瞄准（例如，药物使用、寻求治疗、伴侣暴力、预警 体征意识、心理健康）;试验参与者产后1年内的总PRAMM， 使用预先存在的医疗补助索赔、死亡、出生记录和初级保健计划数据的链接数据集， 这两种措施的差距。这项创新的社区参与试验将把关键发现转化为 PRAMM研究成为一种技术驱动的干预措施，具有很大的成本效益传播潜力。如果 支持，这种方法可以提供一个高度可扩展的方法来减少PRAMM，特别是在 黑人和农村地区。此外，构建PC-PRAMM的新型开源平台将 允许根据新发现、质量改进和区域需求进行长期优化和调整。

Rates of pregnancy-associated and related morbidity and mortality (PRAMM) are far higher in the U.S. than in any other high-income country, particularly in rural areas and among non-Hispanic (NH) Black birthing people. Technology has clear potential for reduction of PRAMM by providing screening, tailored digital content, and connection to live assistance. Digital approaches also provide tremendous scalability and potential for long-term optimization. Finally, technology that is sufficiently flexible and easy to use—as is the platform used in this project—can also support deep community input through direct content creation. The proposed study builds upon an existing app (the Pregnancy Checkup) developed by project PI Ondersma, already integrated with antenatal services throughout Michigan, that provides universal digital screening for health risks, a brief motivational intervention, and referral to services. The proposed project will create the Pregnancy Checkup- PRAMM (PC-PRAMM) by extending the Pregnancy Checkup in two ways: (1) adding elements to address key determinants of PRAMM risks at four distinct levels (individual, support system, provider, and community), with further optimization to address the needs of Black pregnant people and those residing in underserved rural areas; and (2) providing pregnant participants with immediate and secure “live chat” text access to a Community Health Worker who can facilitate warm handoffs to local services. Development of PC-PRAMM will use an innovative community partnered approach to co-creating app content. The PC-PRAMM will target known preventable determinants of PRAMM at four levels throughout pregnancy and the first year postpartum. Our first specific aim is to collaborate with pregnant and postpartum people (including people of color and those from rural areas), healthcare providers, family members, and researchers to develop the PC-PRAMM, including a manual for CHWs providing live chat assistance and facilitating engagement in services. Our second specific aim is to evaluate PC-PRAMM effects using a cluster randomized design in 10 geographically and demographically diverse antenatal care clinics throughout Michigan (N = 500 participants receiving Medicaid and enrolled at less than 20 weeks gestation). We will measure change on an index of PRAMM risk factors directly targeted by the PC-PRAMM (e.g., substance use, treatment-seeking, partner violence, early warning sign awareness, mental health); total PRAMM among trial participants through 1 year postpartum as measured using a pre-existing linked dataset of Medicaid claims, deaths, birth records, and primary care program data, and disparities in both measures. This innovative community-engaged trial will translate key findings from PRAMM research into a technology-driven intervention with strong potential for cost-effective dissemination. If supported, this approach could provide a highly scalable approach to PRAMM reduction, particularly among Black people and in rural areas. Further, the novel open-source platform on which the PC-PRAMM is built would allow long-term optimization and adaptation based on new findings, quality improvement, and regional needs.