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

基本信息

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
项目类别：
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&apos 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

项目摘要

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.

美国严重的孕产妇发病率和死亡率对非裔美国人 (AA) 的影响尤为严重不平等现象存在于许多层面，包括社区、提供者/实践和卫生系统层面。该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 孕产妇问题密歇根州两个县的发病率和死亡率：杰纳西县（包括弗林特）和肯特县（包括弗林特）包括大急流城）。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 女性居民、强化产前和产后护理 (EPC) 工作人员（包括种族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。我们将扩大获得 EPC 服务的机会（即家访计划、尽管健康启动计划是为少数族裔女性设计的，但它采用了远程医疗和灵活的日程安排。密歇根州约 60% 的符合资格的 AA 女性没有参加 EPC 服务试点工作表明，其中 50% 的女性没有参加 EPC 服务。如果我们将提供远程医疗选项，拒绝 EPC 服务的少数族裔妇女将参与。我们将解决提供者和卫生系统隐含的问题。明确的偏见和相应的结构和实践，使这种学习在一天中变得可行体验式培训将包括教学、反思、讨论、挡风玻璃参观和头脑风暴。如何调整参与者的实践和设置，以更好地满足围产期 AA 妇女的需求。包括从医生到前台工作人员的所有人。我们将实施社区干预。针对整个干预县孕产妇健康差异的护理患者安全捆绑包。我们将使用准实验双重差分来测试多层次干预的效果使用倾向评分方法比较前（2016-2019）和后（2021-2024）结果的变化两个干预县的医疗补助妇女与密歇根州其他县的类似妇女。将包括在怀孕期间、分娩时和/或产后 1 年内观察到的所有医疗补助投保妇女， 2016 年至 2024 年期间在密歇根州分娩的患者（约 540,000 名新生儿，其中约 162,000 名 AA 新生儿）将从预先存在的链接数据集中采取措施，其中包括医疗补助索赔、死亡记录、出生记录和 EPC 计划数据的具体目标是： (1) 评估多层次的有效性。对 AA 严重孕产妇发病率和死亡率的干预；(2) 测试改善的服务利用率和非严重孕产妇发病率和死亡率；孕产妇发病率作为多层次干预对严重孕产妇发病率影响的机制，以及（3）评估多层次干预的成本效益该项目将是首批评估的项目之一。一项旨在降低人口层面 AA 孕产妇发病率和死亡率的多层次干预措施。干预措施是否涉及了被认为是干预效果背后的机制，并提供了系统需要做出明智的采用决策、加速实施所需的成本效益数据。