Living Healthy for Moms

项目2：项目摘要/摘要 大多数可预防的孕产妇死亡发生在产中和产后立即(PP)时期，情况也是如此 未被发现/治疗不足的精神健康(MH)状况的并发症(例如自杀、服药过量)和 心血管(CV)事件。在纽约市，黑人的产妇死亡率是黑人的8-12倍 白人出生的父母。然而，大多数以社区为基础的方案解决了分娩个人的健康问题 在这一群体中，一直狭隘地侧重于基本服务(例如，母乳喂养、社会支持)，有限 注重循证护理。全面的干预措施，满足老年人的身体、心理和社会健康需求 关键的PP过渡，并从基于创伤和“风险”的方法过渡到基于力量和授权的方法 都是迫切需要的。医院、社区和政府的许多障碍阻碍了广泛采用和扩展 目前尚不清楚促进者、资产和资源如何提高护理的连续性 以及社区和医院的联系，以支持在纽约市不同地点分娩的个人。助产士的影响- 患者和卫生系统层面的LED干预措施尚未得到严格评估。与 加勒比妇女健康协会和曼哈顿北部围产期伙伴关系，我们将讨论 通过在三个相辅相成的环境中实施和评估妈妈们的健康生活(LHMom)来解决这些差距 和人口(布鲁克林、皇后区和曼哈顿北部)。LHMOMS是一种新型的综合护理干预措施 重点关注出院前开始的护理连续性和社区与医疗保健之间的联系 在出院后的头7天(PD)，并延伸到产后6个月，作为关键窗口 预防长期的身心健康后遗症，同时解决终身健康的关键决定因素 风险。我们开发了几种创新的、以证据为基础的干预措施，包括在线教育 授权计划(使用我们开发的患者激活学习系统平台)建立患者自我 从医院内开始宣传；在危急的前7天由杜拉领导的卫生紧急检测计划 帕金森病；以及创伤知情的DOLA提供的认知行为电话干预，以应对PP抑郁 以及分娩后关键六个月的心血管风险。我们提出了一种严格的、混合的方法 研究LHMom以解决三个具体目标。在目标1中，我们将测试LHMom与注意力的有效性 在三个医院地点对450名随机分娩者进行的混合1型实施试验的对照研究 在布鲁克林、皇后区和曼哈顿北部。这将包括细化和定制针对每个人的干预 网站，以最大限度地提高护理质量，建设杜拉斯提供LHMom的能力，并评估 降低PP抑郁，改善CV健康，创造更好的生活质量。在目标2中，我们将分析 LHMom对PP医疗服务利用和满意度的影响在目标3中，我们将审查实施情况 三个地点LHMom干预的过程和结果。这一项目将推进总体目标 NY-CHAMP为历史上处于不利地位的分娩个人优化PP结果。

PROJECT 2: PROJECT SUMMARY/ABSTRACT Most preventable maternal deaths occur in the intrapartum and immediate postpartum (PP) periods, as do complications from undetected/undertreated mental health (MH) conditions (e.g., suicide, overdose) and cardiovascular (CV) events. In New York City (NYC), maternal deaths are 8–12 times higher for Black than for White birthing parents. However, most community-based programs addressing the health of birthing individuals in this population have been narrowly focused on basic services (e.g., breastfeeding, social support), with limited focus on evidence-based care. Holistic interventions addressing physical, mental, and social health needs in the critical PP transition and moving from trauma- and “risk”-based to a strength- and empowerment-based approach are urgently needed. Many hospital, community, and governmental barriers preclude broad adoption and scaling of doula-delivered care, and it is not known how facilitators, assets, and resources can improve care continuity and community-hospital linkages to support birthing individuals at diverse sites across NYC. The impact of doula- led interventions at patient- and health-system levels have yet to be rigorously evaluated. In collaboration with the Caribbean Women's Health Association and the Northern Manhattan Perinatal Partnership, we will address these gaps by implementing and evaluating Living Healthy for Moms (LHMoms) in three complementary settings and populations (Brooklyn, Queens, and Northern Manhattan). LHMoms is a novel integrated care intervention that focuses intensively on care continuity and community-to-healthcare linkages that starts prior to discharge and during the first 7 days post-discharge (PD) and extends into six months post-partum, as critical windows to prevent long-term physical and mental health sequelae, while also addressing key determinants of lifelong health risk. We have developed several innovative, evidence-based interventions, including an online education empowerment program (using a Patient Activated Learning System platform we developed) to build patient self- advocacy beginning in-hospital; a doula-led health emergency detection program during the critical first 7 days PD; and a trauma-informed doula-delivered cognitive behavioral phone intervention to address PP depression and cardiovascular risks for the critical six months following delivery. We propose a rigorous, mixed-methods study of LHMoms to address three specific aims. In Aim 1, we will test the effectiveness of LHMoms vs. attention control in a Hybrid Type 1 Implementation Trial with 450 randomized birthing individuals at three hospital sites in Brooklyn, Queens, and Northern Manhattan. This will include refining and tailoring the intervention to each site to maximize care quality, building capacity for doulas to deliver LHMoms, and assessing effectiveness in lowering PP depression, improving CV health, and creating better quality of life. In Aim 2, we will analyze the effects of LHMoms on PP healthcare utilization and satisfaction. In Aim 3, we will examine the implementation process and outcomes of the LHMoms intervention at the three sites. This project will advance the overall goals of NY-CHAMP to optimize PP outcomes for historically disadvantaged birthing individuals.