RP2_Harville

在路易斯安那州，那些生活在无法获得孕产妇保健的教区的人被称为“孕产妇保健沙漠”， 在怀孕期间和产后1年内死亡的风险增加91%。黑人女性 已经处于较高的风险独立于他们的居住状态，和县有大量的非西班牙裔 黑人妇女失去所有医院产科服务的几率更高。由于这些大部分农村地区的产科护理 由于不太可能在教区实施，因此迫切需要制定干预措施，改善产妇保健， 这些地区本应用程序的总体目标是检查增强型远程护理的潜力， 改善产妇保健。总的假设是，以社区为基础的创新护理模式 优先事项和背景，可以缓解这些地区缺乏高水平服务的情况。当病人住得远 从护理站点来看，远程护理具有明显的优势，减少了长途旅行的需要，限制了不必要的 关心，及早发现问题。Ochsner的Connected血压监测计划（在家测量血压， 体重监测）已成功地在路易斯安那州南部实施，并与一个 减少早产。然而，黑人和农村妇女不太可能从该方案中受益， 白色和城市女性。该项目将分两个阶段进行：在形成阶段（1-2年）， 项目目标是建立社区需求、关系和基础设施，以进行远程护理 反映社区领导力和优先事项的干预措施（Connected Interaction）。这将是 通过向社区团体展示互联网并确定服务需求来实现， 通过访谈和焦点小组，了解技术挑战和实施干预措施的障碍。 执行阶段项目基础设施，包括协议、程序手册、数据收集工具， 然后将创建提供者培训、数字基础设施和人员配备。在实施阶段（第三年至第四年）， 7），将进行混合有效性-实施阶梯楔形研究，测试实施情况， 过程，以及路易斯安那州北方27个教区的增强型远程护理包的健康结果。 获得护理、健康和实施成果（覆盖范围/收养/忠诚度）将通过 电子健康记录系统，患者满意度和实施结果 （可接受性/适当性）在样本中评估。该项目将产生重要的积极影响， 改善高风险、得不到充分服务的人口的健康，并赋予他们权力。

In Louisiana, those living in parishes that lack access to maternal care, referred to as “maternity care deserts” experience a 91% increase in risk of death during pregnancy and up to 1 year postpartum. Black women are already at higher risk independent of their residential status, and counties with larger numbers of non-Hispanic Black women have higher odds of losing all hospital obstetric services. As obstetric care in these largely rural parishes is unlikely, there is a critical need to develop interventions that will improve maternal health care in these areas. The overall objective of this application is to examine the potential of enhanced remote care to improve maternal health. The overall hypothesis is that innovative models of care, based in community priorities and context, can mitigate the lack of high-level services located in these areas. When patients live far from care sites, remote care has obvious advantages, reducing the need for long trips, limiting unnecessary care, and identifying problems earlier. Ochsner’s Connected MOM program (at-home blood pressure and weight monitoring) has been successfully implemented in southern Louisiana and been associated with a reduction in preterm birth. However, Black and rural women were less likely to benefit from the program that white and urban women. The project will be conducted in two phases: In the formative phase (years 1-2), the project goal is to establish community needs, relationships, and infrastructure to conduct a remote care intervention (Connected MOM+) that reflects the community’s leadership and priorities. This will be accomplished by presenting Connected MOM to community groups and determining the service needs, technological challenges, and barriers to implementation of the intervention, via interviews and focus groups. Implementation phase project infrastructure, including protocols, manuals of procedures, data collection tools, provider training, digital infrastructure, and staffing, will then be created. In the implementation phase (years 3- 7), a hybrid effectiveness-implementation stepped-wedge study will be conducted, testing implementation, process, and health outcomes of the enhanced remote care package across 27 parishes in northern Louisiana. Access to care, health, and implementation outcomes (reach/adoption/fidelity) will be examined via the electronic health record system, and patient satisfaction and implementation outcomes (acceptability/appropriateness) assessed in a sample. This project will have an important positive impact by improving the health of, and empowering, a high-risk, underserved population.