Optimizing utilization of lay health workers to address maternal and child health disparities: A Comprehensive Evaluation of a clinically integrated Breastfeeding Peer Counseling Program

母乳喂养提供独特而深远的母婴健康益处。如果90%的美国父母- 前6个月纯母乳喂养，12个月后补充，超过2600个月 每年可以避免孕产妇死亡和721名婴儿死亡。尽管这些对健康有很大好处 通过母乳喂养，只有45%的美国亲生父母达到了这个6个月的目标，而有色人种和 低收入家庭的人在成功母乳喂养方面面临着额外的障碍，导致患病风险增加一倍 婴儿发病率和死亡率。临床综合母乳喂养同伴咨询(ci-bpc)已被证明 有效促进母乳喂养成果中的种族和经济公平。尽管展示了 尽管CI-BPC的有效性不高，但在方案设计和成本方面仍存在严重的知识差距。因此， 此K01应用程序的科学目标是评估有效的CI-BPC计划的实施 并确定基本的计划活动，确定重要的患者级别和相关背景因素 实施并确定CI-BPC对患者、卫生系统和社会的经济影响。 缩小这些知识差距将通过为以下方面提供框架来支持更广泛地采用CI-BPC 实施和评估。我的中心假设是CI-BPC咨询增加了患者 母乳喂养知识和社会支持，从而增加赋权和减少压力 由ci-bpc带来的母乳喂养率的提高将与较低的医疗成本相关联。 婴儿在产后前6个月的使用情况。具体地说，我的目标是：(1)确定本质 有效的医院CI-BPC计划的计划活动，确定相关的上下文因素，并调整 计划优化黑人和拉丁裔患者的母乳喂养结果；(2)确定 调整后的CI-BPC计划在改善母乳喂养结果、态度、知识和 与标准产前护理相比的支持，以及(3)确定患者、计划、医疗保健和社会 CI-BPC的成本。该项目将评估NorthShore创新的基于医院的CI-BPC计划 大学卫生系统已经显示出母乳喂养差异的显著减少。我的密友 在CI-BPC项目中的作用以及我在混合方法现场和临床研究方面的专业知识 让我具备了承担这样一个项目的技能，但我需要更多的指导和培训 实施科学、临床干预研究和医疗保健经济学。培训和研究 是因为美国妇幼保健方面的差距正在扩大，而且有证据表明 对推广和扩大促进卫生公平的干预措施至关重要。这项创新的研究将 生成有关CI-BPC计划设计和CI-BPC的经济影响的新数据，将为更广泛的人提供信息 实施这一干预措施。此应用程序响应SEN NOT-HS-21-014：AHRQ宣布 关注卫生服务研究以促进卫生公平。

Breastfeeding provides unique and profound maternal and infant health benefits. If 90% of US parent- infant dyads breastfed exclusively for the first six months and supplemented through 12 months, 2600 excess maternal deaths and 721 infant deaths could be averted each year. Despite these substantial health benefits conferred by breastfeeding, only 45% of US birth parents meet this 6-month goal, and parents of color and those in low income families face additional barriers to breastfeeding success, resulting in double the risk of infant morbidity and mortality. Clinically-integrated breastfeeding peer counseling (ci-BPC) has been shown to effectively promote racial and economic equity in breastfeeding outcomes. Despite the demonstrated effectiveness of ci-BPC, there remain critical knowledge gaps regarding program design and costs. Thus, the scientific objective of this K01 application is to evaluate the implementation of an effective ci-BPC program and determine the essential program activities, identify significant patient-level and contextual factors relevant to implementation, and determine the economic impact of ci-BPC for patients, health systems, and society. Closing these gaps in knowledge will support wider adoption of ci-BPC by providing a framework for implementation and evaluation. My central hypothesis is that ci-BPC counselling increases patient breastfeeding knowledge and social support, leading to increased empowerment and reduced stress, and that the improvements in breastfeeding rates conferred by ci-BPC will be associated with lower cost of healthcare utilization for infants in the first 6 months post-delivery. Specifically, I aim: (1) To determine the essential program activities of an effective hospital ci-BPC program, identify relevant contextual factors, and adapt the program to optimize breastfeeding outcomes for Black and Latinx patients; (2) To determine whether the adapted ci-BPC program is more effective at improving breastfeeding outcomes, attitude, knowledge, and support compared to standard prenatal care, and (3) To determine patient, program, healthcare, and societal costs for ci-BPC. This project will evaluate an innovative hospital-based ci-BPC program at NorthShore University HealthSystem that has demonstrated significant reduction in breastfeeding disparities. My intimate role with this ci-BPC program and my expertise in mixed-methods field-based and clinical research has equipped me with the skills to undertake such a project, but I need additional mentorship and training in implementation science, clinical intervention research, and healthcare economics. The training and research are significant because disparities in maternal and child health in the US are growing, and an evidence-basis is essential to replicate and scale up interventions that promote health equity. This innovative research will generate novel data regarding ci-BPC program design and economic impact of ci-BPC that will inform broader implementation of this intervention. This application is responsive to SEN NOT-HS-21-014: AHRQ Announces Interest in Health Services Research to Advance Health Equity.