High reach, multi-level digital intervention for Pregnancy-Related and -Associated Morbidity and Mortality (PRAMM) Disparities

美国与妊娠相关的发病率和死亡率(PRAMM)远远高于美国 任何其他高收入国家，特别是在农村地区和非西班牙裔(NH)黑人生育人口中。 通过提供屏幕、量身定制的数字内容、 以及与现场援助的连接。数字化方法还提供了巨大的可扩展性和潜力 长期优化。最后，足够灵活和易于使用的技术-就像 该项目-还可以通过直接内容创建支持深入的社区输入。拟议的研究建立了 基于Pi Ondersma项目开发的现有应用程序(怀孕检查)，该应用程序已与 整个密歇根州的产前服务，为健康风险提供普遍的数字筛查，简短的 动机干预，并转介到服务。拟议的项目将创建怀孕检查- PRAMM(PC-PRAMM)通过两种方式扩展怀孕检查：(1)添加元素到地址关键字 PRAMM风险的四个不同级别的决定因素(个人、支持系统、提供商和社区)，以及 进一步优化以满足黑人孕妇和那些居住在服务不足的农村地区的人的需要； 以及(2)为怀孕参与者提供对社区健康的即时和安全的“实时聊天”文本访问 可以促进热情移交给当地服务的工人。PC-PRAMM的发展将使用一种创新的 社区合作方式共同创建应用程序内容。PC-PRAMM的目标将是已知可预防的 孕期和产后第一年PRAMM的四个水平的决定因素。我们的第一个特别节目 目的是与孕妇和产后人员(包括有色人种和来自 农村地区)、医疗保健提供者、家庭成员和研究人员开发PC-PRAMM，包括 提供实时聊天协助和促进参与服务的社区卫生服务手册。我们的第二个特例 目的是使用整群随机设计评估PC-PRAMM在10个地区和 密歇根州人口统计多样化的产前护理诊所(N=500名接受医疗补助的参与者 并在怀孕不到20周时登记)。我们将根据PRAMM风险因素指数来衡量变化 PC-PRAMM直接针对的目标(例如，药物使用、寻求治疗、伴侣暴力、预警 体征意识、心理健康)；试验参与者产后1年内的总PRAMM 使用医疗补助申请、死亡、出生记录和初级保健计划数据的预先存在的链接数据集， 在这两个指标上也存在差异。这一创新的社区参与试验将从 PRAMM研究是一种技术驱动的干预措施，具有成本效益传播的强大潜力。如果 这种方法可以为减少PRAMM提供高度可扩展的方法，特别是在 在黑人和农村地区。此外，构建PC-PRAMM的新型开源平台将 允许根据新发现、质量改进和区域需求进行长期优化和适应。

Rates of pregnancy-associated and related morbidity and mortality (PRAMM) are far higher in the U.S. than in any other high-income country, particularly in rural areas and among non-Hispanic (NH) Black birthing people. Technology has clear potential for reduction of PRAMM by providing screening, tailored digital content, and connection to live assistance. Digital approaches also provide tremendous scalability and potential for long-term optimization. Finally, technology that is sufficiently flexible and easy to use—as is the platform used in this project—can also support deep community input through direct content creation. The proposed study builds upon an existing app (the Pregnancy Checkup) developed by project PI Ondersma, already integrated with antenatal services throughout Michigan, that provides universal digital screening for health risks, a brief motivational intervention, and referral to services. The proposed project will create the Pregnancy Checkup- PRAMM (PC-PRAMM) by extending the Pregnancy Checkup in two ways: (1) adding elements to address key determinants of PRAMM risks at four distinct levels (individual, support system, provider, and community), with further optimization to address the needs of Black pregnant people and those residing in underserved rural areas; and (2) providing pregnant participants with immediate and secure “live chat” text access to a Community Health Worker who can facilitate warm handoffs to local services. Development of PC-PRAMM will use an innovative community partnered approach to co-creating app content. The PC-PRAMM will target known preventable determinants of PRAMM at four levels throughout pregnancy and the first year postpartum. Our first specific aim is to collaborate with pregnant and postpartum people (including people of color and those from rural areas), healthcare providers, family members, and researchers to develop the PC-PRAMM, including a manual for CHWs providing live chat assistance and facilitating engagement in services. Our second specific aim is to evaluate PC-PRAMM effects using a cluster randomized design in 10 geographically and demographically diverse antenatal care clinics throughout Michigan (N = 500 participants receiving Medicaid and enrolled at less than 20 weeks gestation). We will measure change on an index of PRAMM risk factors directly targeted by the PC-PRAMM (e.g., substance use, treatment-seeking, partner violence, early warning sign awareness, mental health); total PRAMM among trial participants through 1 year postpartum as measured using a pre-existing linked dataset of Medicaid claims, deaths, birth records, and primary care program data, and disparities in both measures. This innovative community-engaged trial will translate key findings from PRAMM research into a technology-driven intervention with strong potential for cost-effective dissemination. If supported, this approach could provide a highly scalable approach to PRAMM reduction, particularly among Black people and in rural areas. Further, the novel open-source platform on which the PC-PRAMM is built would allow long-term optimization and adaptation based on new findings, quality improvement, and regional needs.