Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality - Administrative Supplement

与妇女会面：多层次干预解决孕产妇发病率和死亡率方面的种族差异 - 行政补充

• 批准号: 10330748
• 负责人: JENNIFER E JOHNSON
• 金额: $ 21.91万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-14 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10330748
• 关键词: Address; Administrative Supplement; Adoption; Affect; African American; Award; Birth; Communities; Community Health Aides; County; Data; Data Set; Death Records; Dimensions; Economics; Education; Funding; Goals; Health system; Home visitation; Information Systems; Intervention; Link; Maternal Health; Maternal Mortality; Measures; Medicaid; Michigan; Morbidity - disease rate; Not Hispanic or Latino; Parents; Pathway interactions; Physicians; Population; Postnatal Care; Pregnancy Complications; Prenatal care; Provider; Race; Records; Research; Risk Factors; Speed; Testing; Time; Woman; Women' s Health; Work; cost effectiveness; effectiveness testing; improved; interdisciplinary approach; intervention effect; maternal morbidity; meetings; mortality; novel; programs; racial disparity; racism; residential segregation; severe maternal morbidity; social determinants

1 Severe maternal morbidity and mortality in the U.S. disproportionately affect African-American (AA) 2 women. Inequities occur at many levels, including community, provider/practice, and health system levels. The 3 parent funded award is testing the effectiveness and cost-effectiveness of a multilevel intervention to address 4 AA maternal morbidity and mortality in two Michigan counties: Genesee County (which includes Flint) and Kent 5 County (which includes Grand Rapids). Interventions were developed or co-developed by our partners in these 6 counties, who include AA women residents, enhanced prenatal and postnatal care (EPC) staff (including race- 7 matched community health workers), and physician/health system staff and providers. 8 Building on our work and the parent funded award, the objective of this supplement is to enhance the 9 understanding of the intersections of racism, residential segregation, other social determinants (e.g. 10 disparities in economic hardship, education), and a variety of other risk factors, on disparities in 11 maternal morbidity and mortality. This supplement will support the long-term goal of our interdisciplinary 12 program of research focused on the disproportionate burden of maternal morbidity and mortality that exists 13 among African American (AA) women, with the potential to reduce the large racial disparities in maternal 14 morbidity and mortality, especially between AA and non-Hispanic white (NHW) women. 15 The research is novel in its contribution to the field of research on the health of women of understudied, 16 underrepresented and underreported (U3) populations and in its use of a multidimensional framework with an 17 interdisciplinary approach to address disparities in maternal health. The supplement will increase the parent 18 project's overall impact by generating additional evidence that will contribute to the understanding of effective 19 interventions and pathways to reduce the large existing disparities in maternal morbidity and mortality. 20 The supplement will leverage funded parent award data from all Medicaid insured women who deliver in 21 Michigan from 2016-2021 (approximately 400,000 births, including 121,500 births to African American women). 22 Measures will be taken from a pre-existing linked dataset that includes Medicaid claims, death records, birth 23 records, and home visiting program data. The funded parent award is among the first to evaluate in a trial a 24 multilevel intervention to reduce AA maternal morbidity and mortality at the population level. The trial tests 25 whether the intervention engages the mechanisms presumed to underlie intervention effects and provides 26 cost-effectiveness data that systems need to make informed decisions about adoption, speeding implementation. 27 The analyses proposed in this supplement will improve the understanding of the mechanisms of the intervention 28 effects by investigating the intersection of a multitude of factors, both internal and external, that influence 29 maternal health and, more specifically, the racial disparities in maternal morbidity and mortality.

1 美国严重孕产妇发病率和死亡率对非裔美国人 (AA) 的影响尤为严重 2 名女性。不平等现象发生在许多层面，包括社区、提供者/实践和卫生系统层面。这 3 家长资助的奖项正在测试多层次干预措施的有效性和成本效益，以解决 4 密歇根州两个县的 AA 孕产妇发病率和死亡率：杰纳西县（包括弗林特）和肯特县 5 个县（包括大急流城）。我们的合作伙伴在这些领域制定或共同制定了干预措施 6 个县，其中包括 AA 女性居民，加强产前和产后护理 (EPC) 工作人员（包括种族- 7 名匹配的社区卫生工作者）以及医生/卫生系统工作人员和提供者。 8 在我们的工作和家长资助的奖励的基础上，该补助金的目的是提高 9 了解种族主义、居住隔离和其他社会决定因素的交叉点（例如 10 经济困难、教育方面的差异以及各种其他风险因素 11 孕产妇发病率和死亡率。该补充材料将支持我们跨学科的长期目标 12 个研究方案侧重于现有孕产妇发病率和死亡率的不成比例的负担 13 在非洲裔美国 (AA) 女性中，有可能减少孕产妇方面的巨大种族差异 14 发病率和死亡率，尤其是 AA 和非西班牙裔白人 (NHW) 女性之间。 15 这项研究对未受研究的妇女健康研究领域的贡献是新颖的， 16 个代表性不足和报告不足 (U3) 人群及其使用多维框架 17 采用跨学科方法解决孕产妇健康方面的差异。补充会增加家长 18 项目的总体影响通过产生额外的证据来帮助理解有效的 19 减少孕产妇发病率和死亡率方面现有巨大差异的干预措施和途径。 20 该补充品将利用所有在医疗补助计划中分娩的受保女性的资助父母奖励数据。 21 2016 年至 2021 年密歇根州（约 400,000 名新生儿，其中 121,500 名非裔美国妇女出生）。 22 措施将从预先存在的链接数据集中采取，其中包括医疗补助索赔、死亡记录、出生记录 23条记录，以及家访节目数据。受资助的家长奖是第一个在试验中评估 24 采取多层次干预措施，降低人口层面的 AA 孕产妇发病率和死亡率。试验测试 25 干预是否涉及了被认为是干预效果背后的机制，并提供了 系统需要 26 个成本效益数据来做出有关采用的明智决策，加速实施。 27 本补充材料中提出的分析将增进对干预机制的理解 通过调查影响内部和外部的多种因素的交叉，得出 28 种效应 29 孕产妇健康，更具体地说，孕产妇发病率和死亡率的种族差异。