Community Care Implementation to Reduce Maternal Health Inequities

研究项目1：实施社区护理以减少孕产妇健康 不平等 随着美国分娩期间和分娩后死亡率和严重并发症的增加， 提高产后护理质量以扭转这些趋势并消除 可预防的孕产妇死亡率、严重的孕产妇发病率和不平等。近年来，产后护理 已被认为是妇女整个生命周期保健连续性的一个重要方面。 重要的是，产后期间的护理不应该只包括一次妇科医生的访问，而是一次全面的检查。 根据妇女的需要进行一系列的探访。基于证据的家访计划显示， 孕产妇和新生儿的结果都有所改善，但尚未显示出对持续存在的 密西西比州产妇发病率和死亡率高，产妇保健方面存在种族差异 δ的此外，密西西比三角洲地区的妇女更容易患产后抑郁症 与母亲相比， 在美国各地。因此，密西西比三角洲的产后护理必须包括临床健康， 心理健康和社会支持。建议的产后家访计划-一个适应 针对高危妇女的基于需求的多成分产后护理和后续计划-将解决 这些差距在照顾。我们的计划是量身定制的，以满足风险母亲的各种需求， 服务不足的密西西比社区具体而言，基于证据的方案要素侧重于关键领域， 重要性：（a）身体健康和慢性病管理，（B）社会工作和财政支持， (c)心理健康和睡眠，以及（d）婴儿护理和喂养。重要的是，该计划将 将产后护理期从一次为期6周的产后检查扩大到至少4次 亲自访视（出院后3周内3次，出院后12周后1次） 母亲）。持续护理将包括与母亲的进一步联系（家访、电话、短信或远程医疗）， 由护士/社区卫生工作者团队安排。社区卫生工作者了解 社区将成为团队的重要成员，并作为母亲的主要联系人。本研究 项目将通过以下目标实施和评估拟议的方案：（1）建立一个 在密西西比实施一项适应性多成分的基于需求的产后护理和随访计划;（2）评估 产后护理和后续计划在提高吸收，信任和满意度方面的有效性;以及 (3)评估产后护理和随访计划在改善临床和心理方面的有效性 产妇保健成果和差距。该研究项目有可能减少严重的孕产妇死亡。 在密西西比经历最严重的孕产妇健康不平等的人群中， 密西西比三角洲卓越研究中心的总体使命。

PROJECT SUMMARY: Research Project 1 - Community Care Implementation to Reduce Maternal Health Inequities As rates of mortality and serious complications during and after childbirth have increased in the United States, so has the focus on improving the quality of postpartum care to reverse these trends and eliminate preventable maternal mortality, severe maternal morbidity, and inequities. In recent years, postpartum care has been recognized as an important aspect of the continuum of women’s healthcare across the life cycle. Importantly, care during the postpartum period should involve not just a single visit to the gynecologist, but a series of visits tailored to the needs of the woman. Evidence-based home visiting programs show measurable improvements in both maternal and newborn outcomes but have yet to show an impact on the persistently high maternal morbidity and mortality rates and the racial disparities in maternal health care in the Mississippi Delta. In addition, women in the Mississippi Delta women are more likely to experience postpartum depressive symptoms and face financial and emotional stressors before and during pregnancy compared with mothers across the United States. Thus, postpartum care in the Mississippi Delta must encompass clinical health, mental health, and social support. The proposed postpartum home visiting program – an adapted multicomponent needs-based postpartum care and follow-up program for high-risk women – will address these gaps in care. Our program has been tailored to meet the various needs of at-risk mothers in underserved Mississippi communities. Specifically, evidence-based program elements focus on areas of key importance: (a) physical well-being and chronic disease management, (b) social work and financial support, (c) psychological well-being and sleep, and (d) infant care and feeding. Importantly, the proposed program will expand the postpartum care period beyond a single 6-week postpartum check-up to include a minimum of four in-person visits (three within 3 weeks of hospital discharge and one visit after 12 weeks to discharge the mother). Continued care will include further contacts (home visit, phone, text, or telehealth) with the mother, scheduled by nurse/ community health worker team. Community health workers with understanding of the community will be essential team members and serve as the primary contact for mothers. This research project will implement and evaluate the proposed program through the following aims: (1) establish an adapted multicomponent needs-based postpartum care and follow-up program in Mississippi; (2) evaluate the effectiveness of the postpartum care and follow-up program in improving uptake, trust, and satisfaction; and (3) evaluate the effectiveness of the postpartum care and follow-up program in improving clinical and mental maternal health outcomes and disparities. This research project has the potential to reduce severe maternal morbidity within populations experiencing the greatest maternal health inequities in Mississippi, supporting the overall mission of the Mississippi Delta Research Center of Excellence for Maternal Health.