Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality - Administrative Supplement

1美国严重的孕产妇发病率和死亡率对非裔美国人(AA)的影响不成比例 两名女性。不平等现象发生在许多层面，包括社区、提供者/诊所和卫生系统层面。这个 3个家长资助的奖项正在测试多级干预的有效性和成本效益，以解决 4密歇根州两个县：杰尼西县(包括弗林特)和肯特县的孕产妇发病率和死亡率 5县(包括大急流城)。干预措施是由我们的合作伙伴在这些领域开发或共同开发的 6个县，其中包括AA女性居民、加强产前和产后护理(EPC)工作人员(包括种族- 7名匹配的社区卫生工作者)，以及医生/卫生系统工作人员和提供者。 8在我们工作和家长资助奖项的基础上，本补充文件的目的是加强 9了解种族主义、居住隔离、其他社会决定因素(例如 10经济困难、教育方面的差距)，以及各种其他风险因素， 11孕产妇发病率和死亡率。这一补充将支持我们的跨学科的长期目标 12研究方案侧重于现有的不成比例的孕产妇发病率和死亡率负担 13在非裔美国人(AA)妇女中，有可能减少孕产妇中巨大的种族差距 14发病率和死亡率，特别是再障妇女和非西班牙裔白人妇女之间的发病率和死亡率。 15这项研究对未得到充分研究的妇女健康研究领域的贡献是新颖的， 16个代表不足和报告不足(U3)的人口，并在其使用具有 17采取跨学科办法解决产妇保健方面的差距。补充剂将增加家长 18项目的总体影响，通过产生有助于理解有效的额外证据 19项干预措施和途径，以减少产妇发病率和死亡率方面存在的巨大差距。 20补贴将利用所有医疗补助参保妇女的资助父母奖励数据，这些妇女 2016-2021年密歇根州21人(约400,000名新生儿，其中包括121,500名非洲裔美国妇女)。 22项措施将从预先存在的关联数据集中进行，该数据集中包括医疗补助申请、死亡记录、出生 23条记录和家访计划数据。受资助的父母奖是第一批在审判中评估 24采取多层次干预措施，在人口一级减少再生障碍性贫血产妇的发病率和死亡率。试验测试 25干预是否使用了被推定为干预效果的基础的机制，并提供了 26成本效益数据，系统需要这些数据来做出有关采用的明智决策，从而加快实施速度。 27本补编中提出的分析将提高对干预机制的理解 28通过调查多种影响因素的交集，包括内部和外部因素 29产妇健康，更具体地说，产妇发病率和死亡率方面的种族差异。

1 Severe maternal morbidity and mortality in the U.S. disproportionately affect African-American (AA) 2 women. Inequities occur at many levels, including community, provider/practice, and health system levels. The 3 parent funded award is testing the effectiveness and cost-effectiveness of a multilevel intervention to address 4 AA maternal morbidity and mortality in two Michigan counties: Genesee County (which includes Flint) and Kent 5 County (which includes Grand Rapids). Interventions were developed or co-developed by our partners in these 6 counties, who include AA women residents, enhanced prenatal and postnatal care (EPC) staff (including race- 7 matched community health workers), and physician/health system staff and providers. 8 Building on our work and the parent funded award, the objective of this supplement is to enhance the 9 understanding of the intersections of racism, residential segregation, other social determinants (e.g. 10 disparities in economic hardship, education), and a variety of other risk factors, on disparities in 11 maternal morbidity and mortality. This supplement will support the long-term goal of our interdisciplinary 12 program of research focused on the disproportionate burden of maternal morbidity and mortality that exists 13 among African American (AA) women, with the potential to reduce the large racial disparities in maternal 14 morbidity and mortality, especially between AA and non-Hispanic white (NHW) women. 15 The research is novel in its contribution to the field of research on the health of women of understudied, 16 underrepresented and underreported (U3) populations and in its use of a multidimensional framework with an 17 interdisciplinary approach to address disparities in maternal health. The supplement will increase the parent 18 project's overall impact by generating additional evidence that will contribute to the understanding of effective 19 interventions and pathways to reduce the large existing disparities in maternal morbidity and mortality. 20 The supplement will leverage funded parent award data from all Medicaid insured women who deliver in 21 Michigan from 2016-2021 (approximately 400,000 births, including 121,500 births to African American women). 22 Measures will be taken from a pre-existing linked dataset that includes Medicaid claims, death records, birth 23 records, and home visiting program data. The funded parent award is among the first to evaluate in a trial a 24 multilevel intervention to reduce AA maternal morbidity and mortality at the population level. The trial tests 25 whether the intervention engages the mechanisms presumed to underlie intervention effects and provides 26 cost-effectiveness data that systems need to make informed decisions about adoption, speeding implementation. 27 The analyses proposed in this supplement will improve the understanding of the mechanisms of the intervention 28 effects by investigating the intersection of a multitude of factors, both internal and external, that influence 29 maternal health and, more specifically, the racial disparities in maternal morbidity and mortality.