Caring for Providers to Improve Patient Experience (CPIPE) Study

项目总结： 据估计，每天发生800例与怀孕有关的死亡。这些死亡大多发生在低收入和中等收入人群中 小岛屿发展中国家(LMIC)，仅撒哈拉以南非洲(SSA)就约占三分之二。卫生设施中的熟练护理是 对改善孕产妇和新生儿结局至关重要。然而，在南非，只有大约三分之二的新生儿发生在 卫生设施--差别很大，特别是在社会经济地位方面。以贫困人口为中心 产妇保健(PCMC)是设施接生率低和不平等的关键驱动因素。此外， 在以设施为基础的分娩率上升的地方，糟糕的初级保健中心会因以下原因导致发病率和死亡率 延迟的、不充分的、不必要的或有害的护理。然而，关于改善干预措施的研究有限 现有的干预措施没有明确解决太平洋岛屿发展中国家中的不平等问题。至 针对这一差距，我们设计了“关爱提供者以改善患者体验”(CPIPE)干预 以解决贫困的初级保健中心的驱动因素，并集中于低收入和中等收入国家弱势妇女的独特需求。CPIPE是一种 理论和循证干预包括5个组成部分：提供者培训、同伴支持、指导、 嵌入式冠军，以及领导力参与度。培训是一门基于模拟的课程， 将关于PCMC、压力、工作倦怠和偏见的内容整合到产科和新生儿急诊护理演习中。我们 以供应商压力和偏见为目标，因为它们是推动贫穷和不公平的相互强化的因素 PCMC。其他干预组件为行为改变创造了有利的环境。我们的飞行员 研究表明，该方法具有较高的可行性、可接受性和初步有效性。因此，我们提出了一个集群 在肯尼亚和加纳的40家大容量分娩医疗机构进行的随机对照试验，以评估 在我们的概念模型中，CPIPE对PCMC以及中期和远期结局的影响。我们将完成 这是通过3个目标。目标1：评估CPIPE对肯尼亚初级保健中心的干预效果 加纳。我们假设CPIPE将改善所有女性，特别是低SES女性的PCMC。我们的 主要结果是通过对母亲的多项横断面调查，用PCMC量表测量PCMC 前9周在基线(干预前)、中线(6个月)的研究设施中分娩 基线后)和终点(基线后12个月)(每个时间点N=2000)。子目标1将评估 CPIPE的成本效益。目的：探讨CPIPE对PCMC的影响机制。我们会 评估CPIPE对提供者知识、自我效能、压力、 职业倦怠和偏见水平；并进行中介分析，以评估这些结果的变化是否占 CPIPE对PCMC的影响目的3：评估CPIPE干预对远端结局的影响，包括 孕产妇寻求保健行为与孕产妇和新生儿健康；并检查PCMC账户是否发生变化 对于这些影响。

PROJECT SUMMARY: An estimated 800 pregnancy-related deaths occur daily. Most of these deaths occur in low- and middle-income countries (LMICs), with about two-thirds in sub-Saharan Africa (SSA) alone. Skilled care in health facilities is critical to improving maternal and neonatal outcomes. Yet, only about two-thirds of births in SSA occur in health facilities—with wide disparities, especially by socioeconomic status (SES). Poor person-centered maternal care (PCMC) is a key driver of both the low rates of facility-based deliveries and disparities. Further, where facility-based childbirth rates have increased, poor PCMC leads to morbidity and mortality due to delayed, inadequate, unnecessary, or harmful care. Yet, there is limited research on interventions to improve PCMC in LMICs; and existing interventions do not explicitly address inequities in PCMC experiences. To address this gap, we designed the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention to address drivers of poor PCMC and center the unique needs of vulnerable women in LMICs. CPIPE is a theory and evidence-based intervention with 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training is a simulation-based curriculum that integrates content on PCMC, stress, burnout, and bias into emergency obstetric and neonatal care drills. We target provider stress and bias because they are mutually reenforcing factors driving poor and inequitable PCMC. The other intervention components create an enabling environment for behavior change. Our pilot studies show high feasibility, acceptability, and preliminary effectiveness. We therefore propose a cluster randomized-controlled trial, in 40 high-volume delivery health facilities in Kenya and Ghana, to assess the impact of CPIPE on PCMC and intermediate and distal outcomes in our conceptual model. We will accomplish this through 3 aims. Aim 1: to assess the effectiveness of the CPIPE intervention on PCMC in Kenya and Ghana. We hypothesize that CPIPE will improve PCMC for all women, and especially for low SES women. Our primary outcome is PCMC measured with the PCMC scale through multiple cross-sectional surveys of mothers who gave birth in the preceding 9 weeks in study facilities at baseline (prior to intervention), midline (6 months post-baseline), and endline (12 months post-baseline) (N=2000 at each time point). A sub-aim 1 will assess the cost-effectiveness of CPIPE. Aim 2: to examine the mechanisms of impact of CPIPE on PCMC. We will assess the effect of CPIPE on intermediate outcomes such as provider knowledge, self-efficacy, stress, burnout, and bias levels; and conduct mediation analysis to assess if changes in these outcomes account for the effect of CPIPE on PCMC. Aim 3: to assess impact of the CPIPE intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health; and examine if changes in PCMC account for these effects.