CTSA Admin Supp2 Maternal Mortality - UL1 - Revision

缺乏产科服务影响了美国2700多万妇女和婴儿， 这对主要是农村国家造成了沉重的资源和财政负担。妊娠期高血压（HTN） 包括先兆子痫（PEC）是一个主要的健康问题，并与显着增加 严重孕产妇发病率（SMM）和死亡率（MM）。管理慢性疾病，如HTN， 特别是在农村地区的孕妇中， 产妇/新生儿结局。然而，使用先进的电信技术来支持和 促进远程临床医疗保健，包括远程医疗和远程病人监护（RPM），可以提供 农村地区的专业医疗保健服务，可以提高护理质量，减少昂贵的再入院 和紧急护理访问，以及降低医疗保健差异。阿肯色州医学科学大学 （UAMS），该州唯一的学术健康科学中心，是唯一的高转诊来源之一， 从阿肯色州农村冒着怀孕的危险。其中许多妇女单程旅行长达4个小时进行产前检查。不 与医疗团队的这种距离不仅给患者带来了经济负担，而且还构成了一种 需要及时采取干预措施的孕妇在这方面遇到障碍。UAMS拥有近15年的 在以农村为主的阿肯色州（AR）开创远程医疗（TM）的经验。这一拟议申请 旨在开发和测试一个协议，以测试RPM的集成监测血压（BP）在怀孕 将血压升高的妇女纳入农村TM诊所的高风险妊娠标准护理， 24/7呼叫中心（CC）这一建议符合《扩大就业行政补充协定》的目标， 研究重点是美国的孕产妇死亡率和妊娠相关发病率，以加强 以证据为基础的护理和预防战略，并改善低资源环境和高资源环境中的成果 负担群体（例如，种族/民族和/或农村）。此外，该提案符合 CTSA U 01赠款的使命，包括扩大临床和转化研究的机会， 沿着临床和转化的影响扩大， 在农村人口中进行研究。总体目标是改善对HTN孕妇的护理， 在农村，低健康资源地区，将RPM纳入当前的TM服务。因此，我们建议 证明具有多水平干预的集成TM+CC+RPM系统将改善患者的 在解决孕产妇发病率和死亡率差异的同时，研究的目的 包括：目标1：制定一个自我监测RPM协议，将其纳入现有的IDHI农村远程医疗 (TM)临床和呼叫中心（CC）模式，用于监测妊娠期HTN。(TM+ CC+ RPM）目标2：执行 评估参与者对RPM设备和集成系统的满意度 使用混合方法。

The lack of obstetric services impacts more than 27 million women and infants in the US and represents significant resource and financial burdens for primarily rural states. Hypertension (HTN) in pregnancy including preeclampsia (PEC) is a major health problem and is associated with significant increased severe maternal morbidity (SMM) and mortality (MM). Management of a chronic condition such as HTN, especially in a pregnant population residing in rural areas, can have a significant impact on optimal maternal/neonatal outcomes. However, the use of advanced telecommunication technologies to support and promote long-distance clinical health care, including telehealth and remote patient monitoring (RPM) can provide rural areas with specialty health care services that can increase the quality of care, reduce costly readmissions and emergent care visits, and lower healthcare disparities. The University of Arkansas for Medical Sciences (UAMS), the only academic health science center in the state, serves as one of the only referral sources for high- risk pregnancies from rural Arkansas. Many of these women travel up to 4 hours one-way for prenatal visits. Not only does this distance from the healthcare team place a burden on the patient financially, it also poses as a barrier to receive timely interventions to pregnant women who require them. UAMS has nearly 15 years of experience pioneering telemedicine (TM) in a primarily rural state, Arkansas (AR). This proposed application aims to develop and test a protocol to test an integration of RPM for monitoring blood pressure (BP) in pregnant women with elevated BP into the standard of care in rural TM clinic for high-risk pregnancies which is supported by a 24/7 Call Center(CC). This proposal in line with goals of the Administrative Supplement to Expand Research Focused on Maternal Mortality and pregnancy-associated morbidity in the U.S. to strengthen evidence-based care and prevention strategies and improve outcomes in low-resource settings and high burden populations (e.g., racial/ethnic and/or rural) within the U.S. Additionally, this proposal aligns with the mission of CTSA U01 grant which includes expanding clinical and translational research opportunities across the lifespan and in underrepresented populations along with expanding the impact of clinical and translational research in and with rural populations. Overall goals is to improve care for pregnant women with HTN who live in rural, low-health resource areas by integrating RPM into current TM services. Therefore, we propose to demonstrate that an integrated TM+CC+RPM system with multi-level intervention will improve patients' compliance and patient care while addressing disparities in maternal morbidity and mortality. The study's aims include: Aim 1: Develop a self-monitoring RPM protocol that integrates into the existing IDHI rural telemedicine (TM) clinic and call center (CC) model for monitoring HTN in pregnancy. (TM + CC+ RPM) Aim 2: Implement the integrated model and assess participants' satisfaction toward the RPM device and the integrated system using a mixed-method approach.