Mayo Clinic Center for Clinical and Translational Science (CCaTS UL1 Supplement - Dr. Regan Theiler)

梅奥诊所临床和转化科学中心（CCaTS UL1 补充 - Regan Theiler 博士）

• 批准号: 10195445
• 负责人: Claudia F. Lucchinetti
• 金额: $ 24.97万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10195445
• 关键词: Accident and Emergency department; Acute; Address; American College of Obstetricians and Gynecologists; Area; Birth; Birthing Centers; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Cessation of life; Characteristics; Clinic; Clinical Sciences; Color; Communication; Communities; Community Health Systems; Consultations; Country; Databases; Developed Countries; Discipline of obstetrics; Disease; Effectiveness; Emergency Situation; Etiology; Event; Facility Accesses; Family Practice; Fright; Future; Geography; Goals; Health Personnel; Health care facility; Health system; Hemorrhage; Hospitals; Incidence; Indigenous; Individual; Infection; Infrastructure; Intervention; Leadership; Left; Life; Link; Maternal Mortality; Medical; Medical emergency; Midwestern United States; Minority; Monitor; Mothers; Nurse Midwives; Patients; Perinatal; Pharmaceutical Preparations; Physicians; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Provider; Research Personnel; Resources; Risk Factors; Rural; Rural Health; Rural Hospitals; Safety; Services; Site; Standardization; Surgeon; System; Techniques; Telemedicine; Testing; Time; Training; Translational Research; Trauma; Travel; United States; Woman; Work; advanced maternal age; adverse maternal outcomes; antenatal; biomedical referral center; care costs; care providers; clinical center; cost; critical access hospital; evidence base; expectation; health care delivery; improved; innovation; intrapartum; maternal condition; maternal health care; maternal morbidity; medical specialties; modifiable risk; novel; obstetric care; prevent; programs; response; rural area; rural underserved; safety and feasibility; safety study; severe maternal morbidity; social health determinants; symposium; trend

Project Summary Background: Startling increases in the rate of maternal mortality in the United States over recent decades put the country at the bottom of industrialized nations when it comes to provision of safe maternity care. Some underlying risk factors have been identified, including a disproportionate burden of maternal mortality among women of color, women of advanced maternal age, and women living in underserved areas. The shortage of both maternity units and Ob/Gyn physicians in rural areas has left many areas without any maternity care providers at all. Because of the multifactorial etiology of the problem, programs seeking to reverse the trend of increasing maternal mortality must address both individual and systemic risk factors associated with adverse maternal outcomes. Objective: The objective of this project is to test the feasibility and safety of a synchronous, remote telemedicine Obstetrics program serving emergency departments and labor and delivery units at small hospitals in the Midwestern United States. Approach: Acute teleOB programs will be implemented at 20 emergency departments and 10 labor and delivery units in the Mayo Clinic Health System, which serves WI, MN, and IA. Using a real-time HD audio/video interface, TeleOB consultants at the level IV maternity unit will guide non-obstetricians through the necessary steps to stabilize patients presenting with obstetric emergencies including hemorrhage, infection, trauma, and cardiovascular events. Because of the low incidence of maternal mortality, severe maternal morbidity will be used as a surrogate “near miss” marker of adverse maternal outcomes. In parallel with service activation, a comprehensive database of births in the Health System (>10,000 per year) will be built to allow comparison of rates and categories of severe maternal morbidity before and after implementation of the TeleOB consultation service. The database will also be used to associate adverse maternal outcomes with medical and social determinants of health, with the goal of identifying modifiable risk factors for maternal morbidity and mortality that are most relevant for each community. Community advisory boards will be engaged to plan service implementation and to disseminate any community-specific findings from the study. Impact: If the TeleOB service demonstrates effectiveness in helping critical access facilities and other small hospitals to stabilize patients presenting with obstetric emergencies, the program will be disseminated to other underserved regions and offered to additional health systems. The scalability of the intervention makes it attractive as a means to reduce geographic inequities and give all women in the U.S. access to high quality emergency obstetric care.

项目摘要 背景：最近几十年来，美国的孕产妇死亡率令人震惊 在提供安全的产妇护理方面，该国处于工业化国家的底部。一些 已经确定了潜在的危险因素，包括对孕产妇死亡率的不成比例 有色妇女，高级产妇时代的妇女以及居住在服务不足地区的妇女。短缺 在粗糙地区，孕妇单位和妇产科医生都在许多地方都没有任何产妇护理 提供者。由于问题的多因素病因，试图扭转趋势的计划 孕产妇死亡率的提高必须解决与逆境相关的个人和全身风险因素 孕产妇的结果。 目的：该项目的目的是测试同步，遥远的可行性和安全性 小型远程医疗妇产科计划，为急诊部门以及劳动力和送货部门提供服务 美国中西部的医院。 方法：急性电视节目将在20个急诊室和10个劳动力中实施 为WI，MN和IA提供服务的Mayo Clinic Health System中的交货单位。使用实时高清 音频/视频界面，IV级产科单位的电视顾问将指导非obstetricians 稳定出现产科紧急的患者的必要步骤，例如出血，感染， 创伤和心血管事件。由于孕产妇死亡率不足，严重的孕产妇 发病率将用作不良产妇结局的代孕“接近”标记。与服务并行 激活是卫生系统中综合的出生数据库（每年> 10,000），以允许 实施之前和之后的严重孕产妇发病率的比率和类别 电视咨询服务。该数据库还将用于将不良母体的结果与 医疗和社会决定者的健康状况，目的是确定母亲的可修改风险因素 与每个社区最相关的发病率和死亡率。社区咨询委员会将是 参与计划实施服务并从研究中传播任何特定于社区的发现。 影响：如果Teleob服务在帮助关键访问设施和其他小型方面表现出有效性 为了稳定出现产科紧急的患者的医院，该计划将被传播给其他 服务不足的地区，并提供给其他卫生系统。干预的可伸缩性使得 有吸引力的一种减少地理不平等并使美国所有妇女获得高质量的手段 紧急产科护理。