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

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

• 批准号: 10398257
• 负责人: JENNIFER E JOHNSON
• 金额: $ 78.09万
• 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/10398257
• 关键词: Address; Adoption; Affect; African American; Behavior; Birth; Birth Records; Businesses; Caring; Child; Communities; Community Health; Community Health Aides; Country; County; Data; Data Set; Death Records; Emergency department visit; Enrollment; Face; Family; Guidelines; Health Status; Health education; Health system; Hearing; Home visitation; Hour; Improve Access; Income; Infant Health; Information Systems; Intervention; Lead; Learning; Life; Link; Maternal Health; Maternal Mortality; Measures; Medicaid; Michigan; Minority Women; Mothers; Not Hispanic or Latino; Occupations; Outcome; Outpatients; Participant; Patient Care; Perinatal; Physicians; Policies; Population; Postnatal Care; Postpartum Period; Pregnancy; Pregnancy Complications; Prenatal care; Provider; Public Health; Quality of Care; Race; Sampling; Sampling Studies; Schedule; Science; Services; Social support; Speed; Structure; System; Testing; Time; Training; Visit; Woman; Women' s Health; Work; base; built environment; care coordination; care systems; cost; cost effectiveness; cost-effectiveness evaluation; design; disparities in morbidity; effectiveness evaluation; effectiveness testing; evidence base; explicit bias; family management; flexibility; health disparity; implicit bias; improved; innovation; intervention effect; maternal morbidity; maternal safety; meetings; mortality; mortality disparity; patient safety; practice setting; programs; racial disparity; response; service utilization; severe maternal morbidity; social health determinants; telehealth

Severe maternal morbidity and mortality in the U.S. disproportionately affect African-American (AA) women. Inequities occur at many levels, including community, provider/practice, and health system levels. This proposal will test the effectiveness and cost-effectiveness of a multilevel intervention to address AA maternal morbidity and mortality in two Michigan counties: Genesee County (which includes Flint) and Kent County (which includes Grand Rapids). Interventions were developed or co-developed by our partners in these counties, who include AA women residents, enhanced prenatal and postnatal care (EPC) staff (including race-matched community health workers), and physician/health system staff and providers. Community level intervention. We will expand access to EPC services (i.e., home visiting programs, Healthy Start programs) using telehealth and flexible scheduling. Despite being designed for minority women, about 60% of eligible AA women in Michigan do not enroll in EPC services. Pilot work indicates that 50% of minority women who declined EPC services would participate if a telehealth option was available. We will provide this option. Provider/practice level intervention. We will address provider and health system implicit and explicit bias and corresponding structures and practices and make this learning actionable using daylong experiential trainings. Training will include didactics, reflection, discussion, windshield tours, and brainstorming ways to tailor participants’ practices and settings to better meet the needs of perinatal AA women. Training will include everyone from physicians to front desk staff. System level intervention. We will implement community care patient safety bundles targeting maternal health disparities throughout the intervention counties. We will test the effects of the multilevel intervention using a quasi-experimental difference-in-difference with propensity scores approach to compare pre (2016-2019) to post (2021-2024) changes in outcomes among Medicaid women in the two intervention counties with similar women in other Michigan counties. The sample will include all Medicaid insured women observed during pregnancy, at birth, and/or up to 1 year postpartum, who delivered in Michigan from 2016 – 2024 (approximately 540,000 births, including ~162,000 births to AA women). Measures will be taken from a pre-existing linked dataset that includes Medicaid claims, death records, birth records, and EPC program data. The specific aims are to: (1) Assess the effectiveness of the multilevel intervention on AA severe maternal morbidity and mortality; (2) Test improved service utilization and non-severe maternal morbidity as mechanisms of the effect of the multilevel intervention on severe maternal morbidity, and (3) Evaluate the cost-effectiveness of the multilevel intervention. This project will be among the first to evaluate a multilevel intervention to reduce AA maternal morbidity and mortality at the population level. The trial tests whether the intervention engages the mechanisms presumed to underlie intervention effects and provides cost-effectiveness data that systems need to make informed decisions about adoption, speeding implementation.

美国的严重孕产妇发病率和死亡率不成比例地影响非裔美国人（AA） 女性。不平等在许多层面上发生，包括社区，提供者/实践和卫生系统级别。这 提案将测试多层次干预措施的有效性和成本效益，以解决AA母体 密歇根州两个县的发病率和死亡率：Genesee县（包括弗林特）和肯特县（ 包括大瀑布城）。干预措施是由我们在这些县的合作伙伴开发或共同开发的 包括AA妇女居民，增强的产前和产后护理（EPC）员工（包括赛车比赛 社区卫生工作者）以及物理/卫生系统的工作人员和提供者。 社区级别的干预。我们将扩大对EPC服务的访问权限（即家庭访问计划， 健康的开始计划）使用远程医疗和灵活的安排。尽管是为少数妇女设计的 密歇根州约60％的合格AA妇女不参加EPC服务。飞行员工作表明50％ 如果有远程医疗选择，拒绝EPC服务的少数民族妇女将参加。我们将提供 此选项。提供者/实践水平干预。我们将与提供者和卫生系统隐式联系，并 明确的偏见和相应的结构和实践，并使此学习可使用一天 体验培训。培训将包括教学，反思，讨论，挡风玻璃之旅和头脑风暴 量身定制参与者的做法和设置的方法，以更好地满足围产期AA妇女的需求。培训意志 包括从医生到前台工作人员的所有人。系统水平干预。我们将实施社区 护理患者安全捆绑包，针对整个干预县的物物健康差异。 我们将使用准实验差异差异测试多级干预的效果 通过承诺分数方法比较PRE（2016-2019）以发布（2021-2024）的预后变化（2021-2024） 在两个干预县的医疗补助妇女与其他密歇根州其他县的妇女相似。样本 将包括所有在怀孕，出生时和/或产后1年期间观察到的医疗补助保险妇女， 他们从2016年至2024年在密歇根州分娩（大约540,000个出生，包括约162,000个出生 女性）。措施将取自现有的链接数据集，其中包括医疗补助索赔，死亡记录， 出生记录和EPC计划数据。具体目的是：（1）评估多级的有效性 干预AA严重的孕产妇发病率和死亡率； （2）测试改进的服务利用率和非严重性 母体发病率是多层次干预对严重孕产妇发病率的影响的机制， （3）评估多级干预的成本效益。该项目将是最早评估的项目之一 多层次干预措施可降低人口水平的AA母体发病率和死亡率。试验测试 干预措施是否介入为干预效果造成的机制，并提供 成本效益数据需要做出有关采用和快速实施的明智决定的数据。