A Pragmatic Trial of Integrating Community-based Patient Navigation into the Continuum of Maternal Care for Black Women in a Safety-Net Health System: Effects on Maternal Health, Health Care, Morbidit

将基于社区的患者导航纳入安全网卫生系统中黑人妇女连续孕产妇护理的务实试验：对孕产妇健康、医疗保健、发病率的影响

• 批准号: 10709629
• 负责人: Rasheeta Chandler
• 金额: $ 71.73万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709629
• 关键词: Address; Adoption; Birth; Black race; Caring; Chronic; Clinical; Communities; Community Health; Data; Data Reporting; Developed Countries; Discrimination; Disparity; Dose; Effectiveness; Elements; Equity; Evaluation; Event; Familiarity; Health; Health Personnel; Health Services; Health system; Healthcare; Hospitals; Improve Access; Inequity; Institution; Institutional Racism; Intervention; Interview; Life; Low income; Maternal Health; Maternal Health Services; Maternal Mortality; Maternal health equity; Measures; Mediator; Mental disorders; Methods; Modeling; Morbidity - disease rate; Mothers; National Institute on Minority Health and Health Disparities; Outcome; Participant; Patients; Perception; Perinatal; Policies; Politics; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Rate; Prenatal care; Preventive care; Primary Care; Process; Quality of Care; Questionnaires; Race; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Review Committee; Sample Size; Severities; Shapes; Social support; Stress; System; Testing; Time Management; Uninsured; Weather; Woman; arm; black women; community based research; cultural competence; depressive symptoms; design; disparity reduction; effectiveness evaluation; ethnic minority; evidence base; experience; health care quality; health care service utilization; health equity; implementation intervention; implicit bias; improved; informant; intervention delivery; maternal morbidity; meetings; metropolitan; mortality; multidisciplinary; patient navigation; patient navigator; postpartum care; pragmatic trial; prenatal; prevent; preventable death; primary outcome; process evaluation; racial disparity; racial minority; racism; recruit; safety net; scale up; secondary outcome; severe maternal morbidity; social; stress symptom; substance use

ABSTRACT US maternal mortality is substantially higher than that of other developed nations, with Georgia ranking second highest among the states. Maternal mortality and severe maternal morbidity (SMM) are increasing in Georgia, with the highest rates among those who are Black, publicly insured or uninsured, and deliver in safety-net hospitals. Maternal morbidity and mortality occur on a continuum in which the accumulation and progression in severity of events can be prevented through access to and utilization of quality health care. Georgia’s Maternal Mortality Review Committee concludes that two-thirds of maternal deaths are preventable and attributes recent increases to rising rates of inadequately managed chronic health conditions, mental health disorders, substance use, and pregnancy complications in the setting of care that is often difficult to access, fragmented and of insufficient quality. Experts emphasize that equity-centered health care approaches – which embed transformational aspects into their design through stakeholder input and Black-led models of care that include social support to counter stress related to racism and weathering – offer the most promise for reducing inequities. Emerging data support that the incorporation of racially-concordant, community-based patient navigators can enhance the cultural-competence of care while addressing discrimination, systemic racism, and institutional barriers to quality care. To date, however, limited research has evaluated this promising strategy in real-life settings using rigorous methods with sufficient sample size and ascertainment of morbidity and mortality endpoints critical for determining effectiveness and motivating large-scale policy and practice change. We posit that the integration of community-based patient navigators into maternal care will improve maternal health outcomes through meeting social needs, lowering stress and depressive symptoms, and improving access to and utilization of care thereby promoting better and more timely management of conditions and reducing the occurrence and progression of complications. To test this hypothesis, we propose to perform a pragmatic randomized controlled trial (RCT) of the integration of community-based patient navigators into the continuum of maternal care, starting prior to mid-pregnancy and continuing through one-year of birth, among 500 Black women with identified health and social needs in a safety-net hospital system to include both outcome evaluation, to discern effectiveness in reducing maternal morbidity and mortality, and process evaluation, to enhance understanding of RCT findings. We will employ the Respectful Maternity Care and the NIMHD Research Frameworks to rigorously evaluate maternal health outcomes in a hospital system that primarily serves Black women with high unmet needs who experience excessive rates of adverse maternal health outcomes via a multi-disciplinary team experienced in health services and community-based research, equity-centered care, and with the capacity to implement a care model intervention with high fidelity and acquire and utilize health system and patient-reported data to conduct comprehensive, high-quality evaluation.

抽象的 美国的物质死亡率大大高于其他发达国家，佐治亚州排名第二 在各州中最高。乔治亚州的孕产妇死亡率和严重的孕产妇发病率（SMM）正在增加 黑人，公共保险或未保险的人的价格最高，并运送安全网 医院。孕产妇的发病率和死亡率发生在连续性中，其中积累和进展 通过获得和利用优质的医疗保健，可以防止事件的严重性。佐治亚州的母亲 死亡率审查委员会得出的结论是，三分之二的孕产妇死亡是可以预防的，并且属于最近 增加了管理不足的慢性健康状况，心理健康障碍的增长速度， 药物使用和怀孕并发症在护理的环境中通常难以获得，分散 质量不足。专家强调以股权为中心的医疗保健方法 - 嵌入 通过利益相关者的投入和黑人领导的护理模型，将其转化为设计 社会支持以抵消与种族主义和风化有关的压力 - 提供减少的最前景 不平等。新兴的数据支持种族依密，基于社区的患者的雇用 导航员可以在解决歧视，系统性种族主义和 质量护理的机构障碍。但是，迄今为止，有限的研究已经评估了这种承诺策略 现实生活中的设置使用严格的方法，并具有足够的样本量和发病率的确定和 死亡率终点对于确定有效性和激励大规模政策和实践改变至关重要。 我们指出，将基于社区的患者导航员整合到孕产妇护理中将改善产妇 通过满足社会需求，降低压力和抑郁症状并改善健康成果 访问和利用护理，从而促进对条件的更好，更及时的管理和 减少并发症的发生和进展。为了检验这一假设，我们建议执行 将基于社区的患者导航员整合到该的务实随机对照试验（RCT） 孕产妇护理的连续性，从怀孕前开始，一直持续到出生一年 在安全网医院系统中，有500名具有确定健康和社会需求的黑人妇女包括 结果评估，以辨别降低母体发病率和死亡率的有效性以及过程 评估，以增强对RCT发现的理解。我们将雇用受人尊敬的产妇护理和 NIMHD研究框架严格评估孕产妇的健康状况，在医院系统中 小学为黑人妇女提供高未满足需求的黑人妇女，她们经历了不良孕产妇的超值率 通过在卫生服务和社区研究方面经验丰富的多学科团队的健康成果， 以股权为中心的护理，并具有高保真度和 获取并利用卫生系统和患者报告的数据来进行全面的高质量评估。