Improving the Quality of Prenatal Care for Low-Income, Black Women

提高低收入黑人女性的产前护理质量

基本信息

批准号：
10557518
负责人：
Sharla Annette Smith
金额：
$ 24.24万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-11 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10557518
关键词：
Address Adherence Adoption American College of Obstetricians and Gynecologists Area Aspirin Birth Black race Blood Pressure Blood Pressure Monitors Caring Cessation of life Child Care Chronic Clinic Clinical Computer software Counseling Data Dose Education Effectiveness Equity Evidence based program Evidence based treatment Feedback Geography Goals Guidelines Health Health behavior High Risk Woman Hybrids Hypertension Incidence Income Individual Insurance Intention Intervention Low income Maintenance Maternal Health Maternal Health Services Maternal Mortality Modeling Monitor Outcome Patient Self-Report Patients Perception Persons Populations at Risk Practical Robust Implementation and Sustainability Model Pre-Eclampsia Pregnancy Pregnant Women Prenatal care Prevention Prevention trial Process Proteinuria Provider Randomized Recommendation Recording of previous events Reduce health disparities Reproduction Research Research Design Risk Risk Factors Rural Self Care Services Site Telemedicine Time Transportation Underserved Population Uninsured Visit Woman Work acceptability and feasibility barrier to care black patient black women blood pressure elevation cost design early onset effectiveness evaluation empowerment evidence base health care disparity health disparity hypertension control implementation barriers implementation evaluation implementation measures implementation outcomes implementation science improved innovation medically underserved medication compliance metropolitan novel patient-level barriers pilot test pregnancy disorder pregnancy health prevent preventable death programs provider-level barriers racial disparity recruit telehealth treatment as usual treatment disparity trend underserved area

Address Adherence Adoption American College of Obstetricians and Gynecologists Area Aspirin Birth Black race Blood Pressure Blood Pressure Monitors Caring Cessation of life Child Care Chronic Clinic Clinical Computer software Counseling Data Dose Education Effectiveness Equity Evidence based program Evidence based treatment Feedback Geography Goals Guidelines Health Health behavior High Risk Woman Hybrids Hypertension Incidence Income Individual Insurance Intention Intervention Low income Maintenance Maternal Health Maternal Health Services Maternal Mortality Modeling Monitor Outcome Patient Self-Report Patients Perception Persons Populations at Risk Practical Robust Implementation and Sustainability Model Pre-Eclampsia Pregnancy Pregnant Women Prenatal care Prevention Prevention trial Process Proteinuria Provider Randomized Recommendation Recording of previous events Reduce health disparities Reproduction Research Research Design Risk Risk Factors Rural Self Care Services Site Telemedicine Time Transportation Underserved Population Uninsured Visit Woman Work acceptability and feasibility barrier to care black patient black women blood pressure elevation cost design early onset effectiveness evaluation empowerment evidence base health care disparity health disparity hypertension control implementation barriers implementation evaluation implementation measures implementation outcomes implementation science improved innovation medically underserved medication compliance metropolitan novel patient-level barriers pilot test pregnancy disorder pregnancy health prevent preventable death programs provider-level barriers racial disparity recruit telehealth treatment as usual treatment disparity trend underserved area

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项目摘要

PROJECT SUMMARY/ABSTRACT: PROJECT 5 (SMITH) Background: The U.S. has the highest rate of maternal deaths in the developed world and over 60% of maternal deaths in the U.S. are preventable. Preeclampsia, a disorder of pregnancy characterized by hypertension and proteinuria, is a top preventable cause of maternal death and an important driver of health disparities in the U.S. Chronic hypertension, a major risk factor for preeclampsia, is estimated to be present in 3% to 5% of all pregnancies but is 60% more prevalent in Black women. Black women carry a 3- to 4-fold greater risk, compared to Whites, of dying from preeclampsia. Research suggest that women at high-risk for preeclampsia recieve 81 to 150 mg of aspirin and counseling on and self-monitor their high blood pressure between 11-16 until 36 weeks of gestation. The brief duration of typical prenatal visits (10 minutes on average) hinders the provider’s ability to deliver evidence-based preeclampsia education and counseling. To date, current research does not, moreover, take advantage of innovative and evidence-based models of prenatal care and hypertension control that have proven feasible for providers and patients. Thus, there is a critical need to implement and deliver guideline-consistent preeclampsia prevention in a sustainable model that removes barriers to care for at-risk Black women. Study Design: The long-term goal of this project is to reduce needless preeclampsia and preeclampsia-related deaths among Black pregnant women by increasing access to evidence-based care. The objective of this study is to refine and pilot test a novel intervention that is designed to address patient and provider barriers to preeclampsia prevention. The intervention, Centering HER (Health, Empowerment, and Reproduction), combines a well-established and effective group prenatal care model—Centering Pregnancy—with a promising telemedicine-based hypertension control program—Take Control of Your Blood Pressure. To meet our study objective, the study proposes the following specific aims: 1) To gain end-user input on the feasibility and acceptability of Centering HER, 2) To pilot the revised Centering HER and collect feasibility and intermediate outcome data, and 3) To determine the effectiveness of Centering HER to improve blood pressure monitoring, aspirin adherence, and implementation measures. Potential Impact: The successful completion of the aims will be important to address the cornerstones of preeclampsia prevention –prenatal care, medication adherence, and blood pressure monitoring and reduce maternal health disparities. If efficacious, Centering HER may be a low cost, sustainable, translatable option ot prevent preeclampsia in at-risk populations.

项目摘要/摘要：项目5（史密斯）背景：美国的生物死亡率最高，超过60％在美国的孕产妇死亡是可以预防的。 Preclamsia，一种特征的怀孕障碍高血压和蛋白尿是孕产妇死亡的最大原因，也是健康的重要驱动力美国慢性高血压的差异是先兆子痫的主要危险因素，据估计存在于在所有怀孕中，有3％至5％的孕妇在黑人妇女中的普遍性高60％。黑人妇女携带3至4倍与白人相比，先兆子痫死亡的风险更大。研究表明，高风险的女性先兆子痫收到81至150毫克的阿司匹林，并在高血压上进行咨询和自我监测妊娠11-16至36周之间。典型产前访问的短暂持续时间（平均10分钟）阻碍了提供者提供基于证据的先兆子痫教育和咨询的能力。迄今为止，此外，当前的研究并不能利用创新和基于证据的产前模型对提供者和患者可行的护理和高血压控制。那是一个关键的需要在可持续模型中实施和提供准则符合准则的预防先兆子痫预防消除了照顾高危黑人妇女的障碍。研究设计：该项目的长期目标是减少黑人孕妇的不必要的先兆子痫和与先兆子痫有关的死亡通过增加访问进行循证护理。这项研究的目的是完善和试点测试一种新颖的干预措施旨在解决预防先兆子痫预防的患者和提供者障碍。干预，以她为中心（健康，授权和繁殖）结合了一个建立良好且有效的团体产前护理模型 - 妊娠 - 具有有希望的基于远程医疗的高血压控制计划 - 获取控制血压。为了满足我们的研究目标，研究提出以下具体目的：1）为了获得有关居中的可行性和可接受性的最终用户的意见，2）试行修订的中心她并收集可行性和中间结果数据，以及3）确定核心的有效性她可以改善血压监测，阿司匹林依从性和实施措施。潜在的影响：成功完成目标对于解决先兆子痫的基石至关重要预防 - 定期护理，药物依从性和血压监测并降低产妇健康差异。如果高效，以她为中心可能是低成本，可持续，可翻译的选择在高风险人群中的先兆子痫。