Caring for Providers to Improve Patient Experience (CPIPE) Study

关爱医疗服务提供者以改善患者体验 (CPIPE) 研究

• 批准号: 10556284
• 负责人: Patience A Afulani
• 金额: $ 65.29万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10556284
• 关键词: Address; Africa South of the Sahara; Automobile Driving; Behavior; Birth; Caring; Cessation of life; Childbirth; Cost Analysis; Cost Effectiveness Analysis; Country; Cross-Sectional Studies; Data; Disparity; Distal; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Emergency Situation; Environment; Equity; Evidence based intervention; Facility Controls; Feedback; Future; Ghana; Grant; Health behavior and outcomes; Health care facility; Inequity; Intervention; Interview; Kenya; Knowledge; Leadership; Maternal Health; Maternal Mortality; Measures; Mediation; Mentorship; Methods; Modeling; Morbidity - disease rate; Mothers; Outcome; Patients; Persons; Pilot Projects; Prevalence; Process; Provider; Randomized, Controlled Trials; Research; Self Efficacy; Socioeconomic Status; Stress; Surveys; System; Time; Training; Trauma; Woman; Women Status; behavior change; burnout; care providers; care seeking; cost; cost effectiveness; design; effectiveness evaluation; effectiveness testing; experience; health seeking behavior; improved; innovation; intervention effect; low and middle-income countries; low socioeconomic status; maternal morbidity; maternal outcome; mortality; neonatal care; neonatal health; neonatal outcome; obstetric care; peer support; person centered; preference; pregnancy related death; primary outcome; simulation; skills; social cognitive theory; theories

PROJECT SUMMARY: An estimated 800 pregnancy-related deaths occur daily. Most of these deaths occur in low- and middle-income countries (LMICs), with about two-thirds in sub-Saharan Africa (SSA) alone. Skilled care in health facilities is critical to improving maternal and neonatal outcomes. Yet, only about two-thirds of births in SSA occur in health facilities—with wide disparities, especially by socioeconomic status (SES). Poor person-centered maternal care (PCMC) is a key driver of both the low rates of facility-based deliveries and disparities. Further, where facility-based childbirth rates have increased, poor PCMC leads to morbidity and mortality due to delayed, inadequate, unnecessary, or harmful care. Yet, there is limited research on interventions to improve PCMC in LMICs; and existing interventions do not explicitly address inequities in PCMC experiences. To address this gap, we designed the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention to address drivers of poor PCMC and center the unique needs of vulnerable women in LMICs. CPIPE is a theory and evidence-based intervention with 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training is a simulation-based curriculum that integrates content on PCMC, stress, burnout, and bias into emergency obstetric and neonatal care drills. We target provider stress and bias because they are mutually reenforcing factors driving poor and inequitable PCMC. The other intervention components create an enabling environment for behavior change. Our pilot studies show high feasibility, acceptability, and preliminary effectiveness. We therefore propose a cluster randomized-controlled trial, in 40 high-volume delivery health facilities in Kenya and Ghana, to assess the impact of CPIPE on PCMC and intermediate and distal outcomes in our conceptual model. We will accomplish this through 3 aims. Aim 1: to assess the effectiveness of the CPIPE intervention on PCMC in Kenya and Ghana. We hypothesize that CPIPE will improve PCMC for all women, and especially for low SES women. Our primary outcome is PCMC measured with the PCMC scale through multiple cross-sectional surveys of mothers who gave birth in the preceding 9 weeks in study facilities at baseline (prior to intervention), midline (6 months post-baseline), and endline (12 months post-baseline) (N=2000 at each time point). A sub-aim 1 will assess the cost-effectiveness of CPIPE. Aim 2: to examine the mechanisms of impact of CPIPE on PCMC. We will assess the effect of CPIPE on intermediate outcomes such as provider knowledge, self-efficacy, stress, burnout, and bias levels; and conduct mediation analysis to assess if changes in these outcomes account for the effect of CPIPE on PCMC. Aim 3: to assess impact of the CPIPE intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health; and examine if changes in PCMC account for these effects.

项目摘要： 估计每天发生800例与妊娠有关的死亡。这些死亡中的大多数发生在低收入和中等收入中 国家（LMIC），仅在撒哈拉以南非洲（SSA）中约有三分之二。卫生设施中的熟练护理是 对于改善孕产妇和新生儿结局至关重要。然而，在SSA中只有大约三分之二的出生 卫生设施 - 具有广泛的分布，特别是社会经济地位（SES）。以人为中心的人 孕产妇护理（PCMC）是基于设施的交付和分配率低的关键驱动力。此外， 在基于设施的分娩率上升的情况下，较差的PCMC导致发病率和死亡率 延迟，不充分，不必要或有害护理。但是，关于改善干预措施的研究有限 LMIC中的PCMC；现有干预措施并未明确解决PCMC体验中的不平等。到 解决这一差距，我们设计了“关心提供者改善患者体验”（CPIPE）干预措施 解决贫困PCMC的驱动因素，并以LMIC中脆弱女性的独特需求为中心。 cpipe是一个 具有5个组成部分的理论和基于证据的干预：提供者培训，同伴支持，Mentalship， 嵌入式冠军和领导力参与。培训是基于模拟的课程 将PCMC，压力，倦怠和偏见的内容集成到紧急产科和新生儿护理训练中。我们 目标提供者的压力和偏见是因为它们是相互强化的因素，驱动较差和不公平的因素 PCMC。其他干预组件为行为改变创造了有利的环境。我们的飞行员 研究表明可行性，可接受性和初步有效性。因此，我们提出了一个集群 在肯尼亚和加纳的40个大批量分娩医疗机构中，随机控制的试验评估 CPIPE对PCMC以及我们概念模型中的中间和远端结果的影响。我们将完成 这是3个目标。目标1：评估CPIPE干预对肯尼亚PCMC和 加纳。我们假设CPIPE将改善所有女性，尤其是低SES妇女的PCMC。我们的 主要结果是通过PCMC量表测量的PCMC通过母亲的多个横截面调查测量 在前9周的基线研究设施（干预之前），中线（6个月） 基线后）和端线（基线后12个月）（每个时间点n = 2000）。 Sub-aim 1将评估 Cpipe的成本效益。目标2：检查CPIPE对PCMC的影响的机制。我们将 评估Cpipe对提供者知识，自效，压力，压力，压力等中级结果的影响 倦怠和偏见水平；并进行调解分析以评估这些结果的变化是否解释了 CPIPE对PCMC的影响。目标3：评估CPIPE干预对远端结果的影响 孕产妇寻求行为以及孕产妇健康；并检查PCMC帐户中的变化是否 这些效果。