Maternal Health Multilevel Intervention/s for Racial Equity (MIRACLE) Center

具体目标(总体)。拟议的多层次干预措施的目标是促进孕产妇健康公平 (奇迹)中心旨在降低与怀孕相关和与怀孕相关的孕产妇发病率和死亡率 (PRAMM)非洲裔美国人、西班牙裔美国人和农村人口通过创新和文化联系- Evant社区合作的有效性和实施研究。该中心将满足以下需求 多层次、以社区为中心、以公平为重点的干预措施的开发和测试，重点是Scala- 灵活性和可持续性，以解决PRAMM的差距。拟议中的奇迹中心具有创新性，因为它： (1)测试在多个卫生系统中运行的补充性、多级孕期到产后干预措施- 项目和设置；(2)解决和测量各种PRAMM情况(包括非严重的 发病率和与妊娠相关的死亡率，较少测量)，以及严重孕产妇 发病率(SMM)和妊娠相关死亡率；(3)分析每个项目的主要影响和协同作用 跨项目的影响，针对不同水平和不同来源的差异；(4)使用全州范围内联系的MED- ICAID数据集(索赔、生命记录、筛查数据)以评估常见结果，从而实现数据协调- 跨项目和与全国其他中心合作；以及(5)侧重于未充分研究的执行情况 放大和可持续发展的科学概念。该中心具有重要意义，因为它：(1)开发和测试小说 在多层次和多系统中解决不平等决定因素的方法，(2)测试这些 在密歇根州20个县开展以人口平等为重点的干预措施，覆盖700万人口；以及 (3)采用公平合作的中心结构，拥有学术和卫生系统或社区绩效指标 居中和每个组件的。所有这些特点都增强了拟议工作的实用性和影响力。穿过 实施和测试多层次干预措施的三个R01范围项目，以及社区伙伴关系和 培训部分该中心将实现以下目标：(1)评估有效性、成本效益- 创新和与文化相关的多层次干预措施的国家知识、实施和全人口影响 通过三个R01范围的项目消除PRAMM差距；(2)产生和扩展创新的AP- 消除PRAMM差异的方法和伙伴关系；(3)最大限度地提高可扩展性、可持续性、文化相关性 改进和广泛传播已确定的方法；(4)增加研究、实践和政策能力 用于消除PRAMM差异。该中心植根于一个文化渊博的多学科研究 社区，长期的社区、卫生和政策合作伙伴参与该中心的所有阶段 工作，并与符合医疗补助资格的黑人和西班牙裔母亲及其家庭在城市和农村建立伙伴关系 设置。在学术和医疗机构的实物财政支持下，该中心将产生可扩展的 拯救产妇生命和结束可预防的、不平等的产妇痛苦的可持续办法。

SPECIFIC AIMS (Overall). The goal of the proposed Multilevel Interventions to Advance Maternal Health Equity (MIRACLE) Center is to reduce pregnancy-related and pregnancy-associated maternal morbidity and mortality (PRAMM) disparities in African American, Hispanic, and rural populations through innovative and culturally rel- evant community-partnered effectiveness and implementation research. This Center will address the need for multilevel, community-centered, equity-focused interventions developed and tested with an emphasis on scala- bility and sustainment to address PRAMM disparities. The proposed MIRACLE Center is innovative because it: (1) tests complementary, multilevel pregnancy-to-postpartum interventions operating across multiple health sys- tems and settings; (2) addresses and measures a wide range of PRAMM conditions (including non-severe mor- bidity and pregnancy-associated mortality, which are less commonly measured), as well as severe maternal morbidity (SMM) and pregnancy-related mortality; (3) analyzes main effects within each project and synergistic effects across projects, which target different levels and sources of disparities; (4) uses a statewide linked Med- icaid dataset (claims, vital records, screening data) to evaluate common outcomes, allowing for data harmoni- zation across projects and with other Centers nationally; and (5) focuses on the understudied implementation science concepts of scale-up and sustainment. The Center is significant because it: (1) develops and tests novel approaches to addressing determinants of inequities at multiple levels and in multiple systems, (2) tests these population-level equity-focused interventions in 20 Michigan counties, covering a population of >7 million; and (3) uses an equitably partnered Center structure, with academic and health system or community PIs of the Center and of each component. All these features enhance utility and impact of the proposed work. Through three R01-scope projects implementing and testing multilevel interventions, and Community Partnership and Training Components the Center will accomplish the following Aims: (1) Evaluate effectiveness, cost-effective- ness, implementation, and population-wide impact of innovative and culturally relevant multilevel interventions to eliminate PRAMM disparities through three R01-scope projects; (2) Generate and scale innovative ap- proaches & partnerships for eliminating PRAMM disparities; (3) Maximize scalability, sustainability, cultural rel- evance, and broad dissemination of identified approaches; (4) Increase research, practice, and policy capacity for eliminating PRAMM disparities. This Center is rooted in a culturally informed multi-disciplinary Research Community with involvement of longstanding community, health, and policy partners in all phases of the Center’s work, and partnership with Black and Hispanic Medicaid-eligible mothers and their families in urban and rural settings. With in-kind financial support from academic and health institutions, the Center will generate scalable and sustainable approaches for saving maternal lives and ending preventable and unequal maternal suffering.