Multidisciplinary sickle cell disease obstetrics care program in Ghana: Non-academic vs.Academic Hospital (Pilot Study)

加纳多学科镰状细胞病产科护理计划：非学术医院与学术医院（试点研究）

• 批准号: 10734007
• 负责人: Eugenia Vicky Asare
• 金额: $ 8.53万
• 依托单位: COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF GHANA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-11 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734007
• 关键词: Acute Pain; Africa; Africa South of the Sahara; Award; Caring; Case Series; Cause of Death; Certification; Cessation of life; Clinic; Clinical; Communication; Complication; Consolidated Framework for Implementation Research; Data Collection; Diagnosis; Discipline of obstetrics; Education; Evidence based practice; Failure; Feasibility Studies; Fetal Monitoring; Focus Groups; Future; General Practitioners; Ghana; Goals; Guidelines; Health Personnel; Hematologist; Hematology; Hospital Administrators; Hospitals; Hybrids; Institution; Intervention; Interview; Joints; Knowledge; Laboratory Scientists; Life; Life Expectancy; Live Birth; Location; Maternal Mortality; Medical; Mentors; Midwife; Needs Assessment; Northern Europe; Odds Ratio; Perception; Perinatal mortality demographics; Physicians; Pilot Projects; Pregnancy; Pregnant Women; Protocols documentation; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Relative Risks; Reporting; Research Design; Resource-limited setting; Resources; Risk Reduction; Scientist; Series; Sickle Cell Anemia; Site; Structure; System; Teaching Hospitals; Technology; Testing; Training and Education; Woman; Work; acute chest syndrome; adjudication; cohort; compare effectiveness; evidence base; experience; hospital care; hybrid type 1 study; implementation process; implementation/effectiveness; improved; low and middle-income countries; maternal morbidity; mortality; multidisciplinary; obstetric care; pediatrician; perinatal morbidity; prevent; programs; prospective; service delivery; skill acquisition; tertiary care

With increasing life expectancy in Africa, pregnancy has become an emerging life-threatening complication in SCD women. In low and middle-income countries, the odds ratio of maternal death associated with SCD is 22.81, 95% CI 14.67–35.46.1 From 2012-2014, the Obstetrics Department, Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, established an obstetrician-led SCD Obstetrics (OB) clinic. The Institutional maternal mortality for SCD over these three years (2012-2014) was approximately 12%. In January 2015, a multidisciplinary SCD OB team was established. The team conducted a combined retrospective/ prospective case series of all maternal deaths in women with SCD at KBTH over seven years (2010-2016).2 This retrospective data collection highlighted failures and challenges to delivering improved care. Acute chest syndrome, preceded by acute pain episodes, was the leading cause of death in nearly 87% of women.2 In May 2015, the team implemented a joint obstetrics/ hematology clinic, instituted close maternal and fetal monitoring, and implemented clinical guidelines/ protocols. In addition, the SCD OB team established a weekly communication system to adjudicate the management of challenging cases. These interventions resulted in an 89.1% risk reduction in maternal mortality (from 10,791 to 1,176 deaths per 100,000 live births; p=0.007) over 13 months.3 Since initiating our multidisciplinary SCD OB program, we have consistently decreased maternal mortality in this cohort by approximately 90% compared to before the team was established.4,5 This physician-mentored application aims to conduct an Effectiveness-Implementation Feasibility Study to extend our results of decreasing maternal mortality from an academic hospital to a non- academic hospital setting in Accra, Ghana with a current maternal mortality rate of 5,940 deaths/ 100,000 live births in SCD women. Over five years, the applicant will acquire the skills to use the Consolidated Framework for Implementation Research (CFIR)6 and the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance)7 to inform the stages of the study. The applicant will test the hypothesis that " In a before and after study design, the applicant will test the hypothesis that multi- disciplinary care and task-shifting in a non-academic hospital for pregnant women with SCD will have an 80% relative risk reduction in death compared to the mortality rate in the same hospital before the multi-disciplinary medical care." The specific aims for this mentored award are: 1) Identify contextual determinants (barriers/ facilitators) that influence the adaptability of the evidence-based practice for establishing a multidisciplinary SCD OB team as an intervention in the non-academic hospital, including the implementation process (Years 1-2); 2) Build capacity for a multidisciplinary SCD OB program in a non- academic hospital (Years 3-5), and 3) Conduct a Hybrid type 1 feasibility study comparing the effectiveness of a task-shifted multidisciplinary SCD OB program in a non-academic site (Years 3-5).

随着非洲的预期寿命增加，怀孕已成为一种危及生命的并发症 在SCD妇女中。在低收入和中等收入国家，与SCD相关的遗产死亡率 IS 22.81，95％CI 14.67–35.46.1 2012- 2014年，Korle-Bu教学医院妇产部 （KBTH），加纳阿克拉，建立了由妇产科主导的SCD妇产科（OB）诊所。机构母亲 在这三年（2012-2014）中，SCD的死亡率约为12％。 2015年1月， 建立了多学科SCD OB团队。该团队进行了回顾/潜在的合并 SCD女性在七年（2010-2016）的SCD女性中所有物质死亡的病例系列。2 回顾性数据收集强调了失败和挑战，以提供改进的护理。急性胸部 综合征在急性疼痛发作之前是近87％的女性死亡的主要原因。2 2015年5月，该小组实施了联合妇产科/血液学诊所，建立了近母校和胎儿 监视并实施临床准则/协议。此外，SCD OB团队建立了一个 每周沟通系统调整挑战案例的管理。这些干预措施 导致孕产妇死亡率的风险降低89.1％（每100,000例活生生的死亡人数从10,791人增加到1,176人； p = 0.007）超过13个月。3自启动我们的多学科SCD OB计划以来 与团队之前，该队列中的材料死亡率降低了约90％ 已建立。4,5这个物理资产的应用程序旨在进行有效性实施 可行性研究以扩展我们从学术医院降低遗产死亡率到非 - 加纳阿克拉的学术医院环境目前的死亡率为5,940人/ 100,000 SCD女性的活产。五年来，申请人将获得使用合并的技能 实施研究框架（CFIR）6和RE-AIM框架（覆盖范围，有效性， 收养，实施和维护）7以告知研究的阶段。申请人将测试 假设“在研究之前和之后，申请人将检验以下假设。 SCD孕妇的非学术医院的纪律护理和任务转移 与同一医院的死亡率相比 多学科的医疗保健。 确定影响基于证据实践的适应性的（障碍/促进者） 建立一个多学科的SCD OB团队作为对非学术医院的干预，包括 实施过程（1 - 2年）； 2）在非 - 学术医院（3-5年）和3）进行比较有效性的混合型1型可行性研究 在非学术地点（3-5年）中的任务班多学科SCD OB计划。