Multilevel community-centered intervention to reduce pregnancy related and associated morbidity and mortality (PRAMM) disparities in Non-Hispanic Black and Hispanic Medicaid-insured individuals

以社区为中心的多层次干预措施，以减少非西班牙裔黑人和西班牙裔医疗补助保险个人中与妊娠相关和相关的发病率和死亡率 (PRAMM) 差异

• 批准号: 10755549
• 负责人: Cristian Ioan Meghea
• 金额: $ 73.8万
• 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/10755549
• 关键词: Active Learning; Address; Advocacy; Advocate; Area; Awareness; Birth; Birth Records; Black race; Caring; Clinical; Communication; Communities; Community Health; Community Health Aides; Community Healthcare; Complement; Complex; County; Data; Death Records; Disparity; Education; Educational Curriculum; Effectiveness of Interventions; Equity; Face; Health Services Accessibility; Health system; Hearing; Hispanic; Home visitation; Hypertension; Individual; Information Systems; Infrastructure; Intervention; Knowledge; Learning; Link; Maternal Health; Maternal Mortality; Medicaid; Mental Health; Methods; Michigan; Modeling; Not Hispanic or Latino; Nurses; Outcome; Participant; Patients; Perinatal; Persons; Policies; Population; Populations at Risk; Postpartum Period; Pregnancy; Provider; Quality of Care; Quasi-experiment; Racial Equity; Recording of previous events; Reporting; Research; Science; Social Conditions; Social Workers; Standardization; Structural Racism; System; Testing; Training; Work; beneficiary; care systems; clinical care; community center; community setting; comorbidity; cost effectiveness; cost-effectiveness evaluation; design; disparities in morbidity; disparity reduction; early pregnancy; effectiveness evaluation; empowerment; evidence base; health disparity; innovation; intervention effect; maternal morbidity; mortality; mortality disparity; multiple chronic conditions; postnatal; pragmatic trial; pregnant; prenatal; programs; provider factors; racism; severe maternal morbidity; skills; testing access; treatment as usual

In this project we will test a multilevel intervention in a large-scale pragmatic trial to reduce Non-Hispanic Black (NHB) and Hispanic pregnancy-related and -associated maternal morbidity and mortality (PRAMM) disparities in three Michigan counties with over ¼ (>2.5M) of the Michigan population. Interventions at each level were co- developed with our partners in these counties, including NHB and Hispanic pregnant persons, community lead- ers, providers, and health system representatives. Community level intervention. We will enhance a commu- nity health worker (CHW)-inclusive home visiting model by increasing pre- and postnatal focus on maternal health and by designing and implementing specific CHW interventions to directly address PRAMM equity in Black and Hispanic Medicaid birthing persons. This approach takes advantage of existing statewide infrastruc- tures in MI and many other states to expand the reach of maternal health disparities interventions. The pro- vider/practice level intervention will address patient-provider interactions through actionable, experiential pro- vider trainings focused on communication (e.g. listening to birthing persons), provider and practice racism, bias, cultural relevance, and awareness of and referrals to community care services including CHWs and home visit- ing, for both clinical and community settings. The study is innovative in that (i) it is the first large-scale test of a scalable and integrated CHW – home visiting program specifically designed for reducing PRAMM and disparities among NHB and Hispanic birthing persons; (ii) will include interventions for specific comorbid conditions relevant to PRAMM and disparities, including multimorbidity; (iii) will be one of the first to address patient-provider inter- actions both from the provider and patient perspective and will incorporate innovative upstream provider training methods such as community health detailing; (iv) and will enhance the coordination of clinical and community care at multiple levels. The study will use a quasi-experimental, stepped wedge design. Participants will be Medicaid insured persons in Wayne, Kent, and Genesee counties observed during pregnancy, at birth, and up to 1 year postpartum, who deliver a birth between 2021-2028 (~101,000 births, including ~39,000 NHB and Hispanic). Analyses will use a statewide linked data system including all Medicaid birth and death records, Med- icaid claims, and other program data. In the context of Michigan extending pregnancy-related Medicaid coverage to 12 months postpartum starting in 2022, the study will be able to evaluate the impact of the proposed multilevel intervention vs usual care from early pregnancy through 12 months postpartum. Specific aims are to: (1) Assess the effectiveness of the intervention (vs usual care) in reducing NHB and Hispanic PRAMM (up to 1-year post- partum; overall & relative to NHW persons) and NHB and Hispanic severe maternal morbidity and pregnancy- associated (which includes pregnancy-related) mortality (overall & relative to NHW persons); (2) Test access to care, quality, and social conditions as mechanisms of the effect of the multilevel intervention on NHB and His- panic PRAMM disparities; (3) Evaluate the cost-effectiveness of the multilevel intervention.

在这个项目中，我们将测试一个多层次的干预，在一个大规模的务实的试验，以减少非西班牙裔黑人 (NHB)与西班牙裔妊娠相关和相关孕产妇发病率和死亡率（PRAMM）的差异 在密歇根州的三个县，密歇根州的人口超过1/4（> 250万）。各级的干预措施都是共同的， 与我们在这些县的合作伙伴一起开发，包括NHB和西班牙裔孕妇，社区领导， 医疗服务提供者和卫生系统代表。社区一级的干预。我们将加强沟通- 社区卫生工作者（CHW）--通过增加对孕产妇产前和产后的关注，建立包容性的家访模式 通过设计和实施具体的社区卫生工作干预措施，直接解决农村妇女参与和管理的平等问题， 黑人和西班牙裔医疗补助生育者。这种方法利用现有的全州基础设施， 在密歇根州和其他许多州开展了一些活动，以扩大孕产妇健康差异干预措施的覆盖面。亲- vider/practice水平的干预将通过可操作的、经验丰富的专业人员来解决患者与提供者之间的互动问题， vider培训的重点是沟通（例如倾听分娩者）、提供者和做法，种族主义，偏见， 文化相关性，以及对社区护理服务（包括社区卫生工作者和家访）的认识和转介- 在临床和社区环境中。这项研究的创新之处在于：（i）它是第一次大规模测试 可扩展的综合CHW -专为减少PRAMM和差异而设计的家访计划 在NHB和西班牙裔生育者中;（ii）将包括针对特定共病状况的干预措施， （三）将是第一个解决病人-提供者之间的差异， 从供应商和患者的角度采取行动，并将纳入创新的上游供应商培训 （iv）加强临床和社区卫生服务的协调， 在多个层次上照顾。本研究将采用准实验性阶梯式楔形设计。参与者将被 韦恩、肯特和杰内塞县的医疗补助被保险人在怀孕期间、出生时及以后的情况 到产后1年，在2021-2028年之间分娩（约101，000例分娩，包括约39，000例NHB和 西班牙裔）。分析将使用全州范围内的链接数据系统，包括所有医疗补助出生和死亡记录，医疗保险， icaid索赔和其他程序数据。在密歇根州扩大与怀孕有关的医疗补助覆盖范围的背景下， 从2022年开始，到产后12个月，该研究将能够评估拟议的多层次 从怀孕早期到产后12个月的干预与常规护理。具体目标是：（1）评估 干预（与常规护理相比）在减少NHB和西班牙裔PRAMM（长达1年后）方面的有效性 分娩;总体和相对于NHW人群）以及NHB和西班牙裔严重孕产妇发病率和妊娠- 相关（包括妊娠相关）死亡率（总体和相对于NHW人员）;（2） 护理、质量和社会条件作为多层次干预对NHB和His的影响机制， （3）评估多层次干预的成本效果。