Adaptation of an Evidence-Based Curriculum to Teach the Prevention, Evaluation and Treatment of Maternal Medical Emergencies for Pre-hospital & Hospital Healthcare Workers in Rural Context

项目总结/摘要 在美国，孕产妇死亡率和严重的孕产妇发病率正在上升，尽管大多数 这些后果是可以通过及时和适当的护理预防的。大多数医疗急救人员 熟练护理经历孕产妇医疗紧急情况的患者，包括孕产妇心脏病 逮捕了这种差距存在于第一反应者和跨医学专业，甚至是产科专家 接受过高级心血管生命支持培训妇女医疗保健领域的领先组织 复苏都呼吁努力更好地准备保健工作者（HCW）的孕产妇医疗 越来越多的联邦机构和州立法机构正在激励或要求医院 提供这种教育和培训。尽管如此，对产妇进行循证教育的工作仍有待进一步开展。 美国各地卫生系统的医疗紧急情况不一致，国家认证标准也不一致。 不存在.该研究小组开发了产科生命支持TM（OBLSTM），这是第一个跨学科的 模拟课程，培训医院和院前医务人员预防、识别和管理 产妇医疗紧急情况。一项随机交叉试验的初步数据显示， 与对照组相比，干预组的临床能力、知识和信心有所改善。 对照到目前为止，OBLSTM培训已经在高资源环境中与HCW一起实施， 最佳复苏资源（例如，大量输血方案，体外膜氧合， 接受过剖腹产复苏训练的医疗急救人员）。然而，农村和低资源地区的保健妇女 设置可能面临压力（例如，金融、劳动力短缺、基础设施不发达）， 从高资源设置，并要求适应OBLSTM的学习目标，内容和交付 模式，以优化医疗急救护理在这些情况下。本项目的目标是适应OBLSTM 在农村和低资源环境中实施。农村将根据城乡通勤定义 区域（RUCA）代码。低资源设置是指由一角钱三月指定的县， 获得产妇护理。这项研究将在康州大学健康与东北合作进行 农村医院协会和达特茅斯农村紧急服务和创伤健康中心。的 执行研究和干预措施规划综合框架将指导执行工作 规划和适应过程。具体而言，本研究旨在：（1）识别障碍和促进因素， 在农村和低资源环境中实施OBLSTM;（2）有系统地使OBLSTM适用于卫生保健工作者 在农村和低资源环境中进行实践;（3）实施和评估适应课程（OBLSTM - 远程访问）在新英格兰的农村社区。将采用混合方法。 这项研究的结果将用于促进国家扩大这一重要的医疗保健创新， 改善病人安全和减少孕产妇发病率和死亡率方面的不平等的目标。

PROJECT SUMMARY/ABSTRACT Maternal mortality and severe maternal morbidity are increasing in the United States (US) despite most of these outcomes being preventable with timely and appropriate care. Most medical responders are not optimally proficient in caring for patients who experience maternal medical emergencies, including maternal cardiac arrest. This gap exists among first responders and across medical specialties, and even for OB-specialists trained in Advanced Cardiovascular Life Support. Leading organizations in women’s health care and resuscitation have all called for efforts to better prepare healthcare workers (HCWs) for maternal medical emergencies, and increasingly federal agencies and state legislatures are incentivizing or requiring hospitals to provide this education and training. Nonetheless, the implementation of evidence-based education for maternal medical emergencies in health systems across the US is inconsistent and national credentialing standards do not exist. The study team developed Obstetric Life SupportTM (OBLSTM), the first of its kind interdisciplinary simulation curriculum to train hospital-based and prehospital HCWs on preventing, recognizing, and managing maternal medical emergencies. Preliminary data from a randomized, cross-over trial shows significant improvement in clinical competencies, knowledge, and confidence for the intervention group compared to the controls. To date, OBLSTM training has been implemented with HCWs in high-resource settings with access to optimal resuscitation resources (e.g., massive transfusion protocol, extracorporeal membrane oxygenation, medical responder trained in resuscitative cesarean delivery). However, HCWs in rural and low-resource settings may face pressures (e.g., financial, workforce shortages, underdeveloped infrastructure) that differ from high-resource settings, and require adaptations to OBLSTM’s learning objectives, content, and delivery mode to optimize medical emergency care in these contexts. The objective of this project is to adapt OBLSTM for implementation in rural and low-resource settings. Rural will be defined based on Rural-Urban Commuting Area (RUCA) codes. Low-resource settings are counties designated by March of Dimes as having low or no access to maternity care. The study will be conducted at UCONN Health in partnership with the Northeast Rural Hospital Association and the Dartmouth Health Center for Rural Emergency Services and Trauma. The Consolidated Framework for Implementation Research and Intervention Mapping will guide the implementation planning and adaptation process. Specifically, the study aims to: (1) Identify barriers and facilitators to implementation of OBLSTM in rural and low-resource settings; (2) Systematically adapt OBLSTM for HCWs practicing in rural and low-resource settings; and (3) Implement and evaluate the adapted curriculum (OBLSTM – Remote Access) in rural communities in New England. A mixed methods approach will be employed. Findings from this study will be used to promote national scale-up of this important health care innovation with the goal of improving patient safety and reducing inequities in maternal morbidity and mortality.