NHLBI Community Engagement Technical Assistance Center (CETAC)

NHLBI 社区参与技术援助中心 (CETAC)

• 批准号: 10932552
• 负责人: Chanza Baytop
• 金额: $ 6362.67万
• 依托单位: WESTAT, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10932552
• 关键词: Address; Affect; Area; Behavior; Behavioral; Biological; Black race; Cardiomyopathies; Cardiovascular system; Caring; Cause of Death; Clinical; Communities; Complex; Conceptions; Coping Behavior; Development; Discrimination; Eclampsia; Embolism; Ensure; Environmental Risk Factor; Ethnic Origin; Exposure to; Family; Funding Opportunities; Future; Gestational Diabetes; Goals; Health; Health Disparities Research; Health Priorities; Health Sciences; Health Status; Healthcare Systems; Hemorrhage; Hypertension; Infection; Infrastructure; Life Cycle Stages; Longevity; Maternal Health; Maternal Mortality; Mental Health; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Needs Assessment; Not Hispanic or Latino; Obesity; Outcome; Play; Population Heterogeneity; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Primary Care; Psyche structure; Race; Research; Risk Factors; Role; Scientist; Sleep Disorders; Smoking; Strategic Planning; Strategic vision; Stress; Support Groups; Testing; United States; United States National Institutes of Health; Woman; Women' s Health; Work; antenatal; caregiving; community engagement; community organizations; community partnership; evidence base; experience; implicit bias; improved; insight; intrapartum; maternal morbidity; mortality; opioid use; programs; protective factors; psychologic; social; social determinants; theories; trend

Over the past three decades, there have been alarming upward trends in the rates of maternal morbidity and mortality in the United States. Overall, the identified clinical causes of maternal death are: cardiovascular conditions (14%), hemorrhage (13%), infection (11%) embolism (10%), cardiomyopathy (95), mental health conditions (9%) and preeclampsia/eclampsia (8%) but these conditions vary by race/ethnicity. For Black, non-Hispanic women, the two leading causes of death were cardiomyopathy and cardiovascular conditions, and mental conditions was the leading cause among White, non-Hispanic women.1 Obesity, hypertension, smoking, opioid use and sleep disorders are also conditions and behaviors that have been found to be associated with maternal morbidity such as hemorrhage, preeclampsia and cardiomyopathy. These could potentially be addressed in primary care before and between pregnancies.2-6 The National Heart, Lung Blood Institute (NHLBI) is participating in a trans-National Institutes of Health (NIH) effort to improve women’s health, particularly maternal morbidity and mortality. A plan – Advancing Science for the Health of Women, The Trans-NIH Strategic Plan for Women’s Health Research – was developed for the period 2019 – 2023. This plan provides a framework that recognizes the complex interactions of multiple factors that affect women’s health across the life course, including pregnancy. Life course theory posits that health development begins before conception and continues across the life span. It suggests that a complex play of biologic, behavioral, psychological, and social protective and risk factors contribute to health outcomes, and that health status reflects the cumulative lifetime exposure to these factors. The guiding principles for this plan are consideration of the complex factors affecting women’s health, the inclusion of diverse populations that are disproportionately affected by morbidity and mortality, and active engagement of a diverse group of scientists.7 The NIH approach to reducing maternal morbidity and mortality will aim to enhance health disparities research, increase the understanding of social determinants and other risk factors (including environmental risk factors), improve care (antepartum, intrapartum and postpartum) and management, provide insight to psychological exposures such as stress, discrimination and caregiving, understand coping behaviors in families affected by maternal morbidity or mortality, and investigate the role of implicit bias in the health care systems regarding pregnancy.8 Within NHLBI, maternal and women’s health priorities span all of the objectives of the NHLBI strategic vision, and NHLBI has supported a number of maternal health programs looking at hypertension, sleep disorders, and other pregnancy complications including pre-eclampsia, eclampsia, and gestational diabetes. The goal of the NHLBI 3M Administrative Coordinating Center (3M ACC) is to engage communities and networks in areas that experience high levels of maternal morbidity and mortality. The 3M ACC will support the preliminary work necessary to identify and prepare a group of community-based organizations to respond to future funding opportunities. The 3M ACC will develop the infrastructure to support this group of Maternal Morbidity and Mortality Regional Coalitions (3M RCs) and provide scientific support and coordination to NHLBI on emerging scientific needs. Specifically, the 3M ACC will support these programmatic objectives: • Identify research groups and organizations with existing and relevant expertise and community partnerships. • Conduct landscape analyses and community-informed needs assessments. • Identify within each community implementation opportunities and barriers to improve delivery of evidence-based care to reduce maternal morbidity and mortality. • Develop and conduct early-stage tests of implementation approaches to identify potential strategies to ensure the proposed approaches are acceptable, feasible, scalable, and sustainable and to identify barriers.

在过去三十年中，孕产妇死亡率呈惊人的上升趋势， 美国的发病率和死亡率。总的来说，确定的产妇死亡的临床原因 死亡原因为：心血管疾病（14%）、出血（13%）、感染（11%）和栓塞 (10%）、心肌病（95）、精神健康状况（9%）和先兆子痫/子痫（8%） 但这些条件因种族/民族而异。对于黑人，非西班牙裔妇女，两个主要的 死亡原因是心肌病和心血管疾病， 是白色非西班牙裔女性的主要原因。1肥胖、高血压、吸烟、 阿片类药物使用和睡眠障碍也是已发现的 与产妇发病率相关，如出血、先兆子痫和心肌病。 这些问题有可能在怀孕前和怀孕之间的初级保健中得到解决。 国家心肺血液研究所（NHLBI）正在参加一个跨国家的研究所， 国家卫生研究所努力改善妇女健康，特别是产妇发病率和死亡率。一 计划-推进科学促进妇女健康，跨国家卫生研究院妇女健康战略计划 健康研究-为2019 - 2023年期间开发。该计划提供了一个框架 认识到影响妇女健康的多种因素的复杂相互作用， 包括怀孕在内的生命周期。生命历程理论认为，健康发展始于 在受孕之前，并持续整个生命周期。这表明，一个复杂的游戏， 生物、行为、心理和社会保护和风险因素有助于健康 健康状况反映了这些因素的终生累积暴露。的 该计划的指导原则是考虑影响妇女就业的复杂因素， 健康，包括不成比例地受到发病率影响的各种人口， 死亡率，以及各种科学家群体的积极参与。 国家卫生研究院降低孕产妇发病率和死亡率的方法旨在提高健康水平， 差异研究，增加对社会决定因素和其他风险因素的了解 （包括环境风险因素），改善护理（产前、产时和产后） 和管理，提供洞察心理暴露，如压力，歧视和 了解受孕产妇发病率或死亡率影响的家庭的应对行为， 并调查医疗保健系统中关于怀孕的隐性偏见的作用。 《国家保健法》、孕产妇和妇女保健优先事项涵盖《国家保健法》战略的所有目标 愿景，NHLBI支持了一些孕产妇健康计划， 高血压、睡眠障碍和其他妊娠并发症，包括先兆子痫， 子痫和妊娠糖尿病 NHLBI 3M行政协调中心（3M ACC）的目标是 孕产妇发病率高的地区的社区和网络， mortality. 3M ACC将支持必要的初步工作，以确定和准备 一个社区组织小组，以应对未来的供资机会。的3m 行政协调会将发展基础设施，以支持这一组产妇死亡率和死亡率 区域联盟（3M区域委员会），并就以下问题向国家HLBI提供科学支持和协调： 新兴的科学需求。具体而言，3M ACC将支持这些方案目标： ·确定具有现有和相关专业知识的研究小组和组织， 社区伙伴关系。 ·进行景观分析和社区知情的需求评估。 ·确定每个社区内的实施机会和障碍，以改善 提供循证护理，以降低孕产妇发病率和死亡率。 ·制定并进行实施方法的早期测试，以确定潜在的 确保所提出的方法可接受、可行、可扩展， 可持续发展和识别障碍。