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

针对妊娠相关和相关发病率和死亡率 (PRAMM) 差异的高覆盖范围、多层次数字干预

• 批准号: 10755550
• 负责人: Claire E Margerison
• 金额: $ 74.91万
• 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/10755550
• 关键词: Abnormal coordination; Address; Adopted; Awareness; Behavioral; Birth; Birth Records; Black Populations; Black race; Cessation of life; Clinic; Collaborations; Color; Communities; Community Health Aides; Country; Data; Data Set; Development; Disparity; Early identification; Elements; Enrollment; Ensure; Family member; Feedback; Geography; Health; Health Personnel; Health Services Accessibility; Home visitation; Income; Individual; Intervention; Knowledge; Life Style; Link; Manuals; Maternal Health; Maternal Mortality; Measures; Mediation; Medicaid; Mental Depression; Mental Health; Michigan; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Participant; Patients; Persons; Postpartum Period; Pregnancy; Pregnancy Rate; Primary Care; Privatization; Provider; Racial Equity; Recommendation; Research; Research Personnel; Resources; Risk; Risk Factors; Rural; Sampling; Secure; Services; Site; Social support; Structure; Support System; Symptoms; Technology; Text; Translating; antenatal; antenatal care; brief motivational intervention; checkup examination; cluster randomized design; community-level factor; cost effective; cost effectiveness; design; digital; digital intervention; disparities in morbidity; efficacy testing; flexibility; health care settings; implicit bias; improved; indexing; ineffective therapies; innovation; maternal morbidity; mortality; mortality disparity; mortality risk; novel; open source; partner violence; people of color; pregnant; primary outcome; programs; provider communication; provider factors; randomized trial; residence; rural area; scale up; screening; secondary outcome; service providers; social; social stigma; substance use; underserved rural area; urban area; urban residence

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.

美国与妊娠相关的发病率和死亡率 (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) 黑人出生的人群中。 通过提供筛选、定制数字内容、 以及与实时援助的连接。数字化方法还提供了巨大的可扩展性和潜力 长期优化。最后，技术足够灵活且易于使用——就像所使用的平台一样 该项目还可以通过直接内容创建来支持深入的社区投入。拟议的研究构建 基于 PI Ondersma 项目开发的现有应用程序（怀孕检查），已与 整个密歇根州的产前服务，提供针对健康风险的通用数字筛查，简要介绍 动机干预和转介服务。拟议的项目将创建怀孕检查- PRAMM（PC-PRAMM）通过两种方式扩展怀孕检查：（1）向地址键添加元素 PRAMM 风险的决定因素分为四个不同层面（个人、支持系统、提供者和社区），其中 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； (2) 为怀孕参与者提供即时、安全的“实时聊天”文本访问社区健康中心 能够促进与当地服务的热情交接的工作人员。 PC-PRAMM 的开发将采用创新的 社区合作方式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，PRAMM 在四个水平上的决定因素。我们的第一个具体 目标是与孕妇和产后人士（包括有色人种和来自不同种族的人）合作 农村地区）、医疗保健提供者、家庭成员和研究人员来开发 PC-PRAMM，包括 为社区卫生工作者提供实时聊天帮助和促进服务参与的手册。我们的第二个具体 目的是使用集群随机设计在 10 个地理和地区评估 PC-PRAMM 效果 密歇根州人口多样化的产前保健诊所（N = 500 名接受医疗补助的参与者 并在妊娠 20 周以内入组）。我们将衡量 PRAMM 风险因素指数的变化 PC-PRAMM 的直接目标（例如，药物使用、寻求治疗、伴侣暴力、预警 标志意识、心理健康）；测量的试验参与者在产后 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， 以及两种措施的差异。这项创新的社区参与试验将转化来自 PRAMM 研究技术驱动的干预措施，具有巨大的成本效益传播潜力。如果 如果得到支持，这种方法可以提供一种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 的新颖开源平台将 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。