A standardized labor induction protocol to reduce primary cesarean and racial disparities in labor outcomes: a prospective cohort study

减少初次剖宫产和分娩结果种族差异的标准化引产方案：一项前瞻性队列研究

基本信息

批准号：
10680428
负责人：
Rebecca Feldman Hamm
金额：
$ 16.99万
依托单位：
UNIVERSITY OF PENNSYLVANIA
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：
2020-09-01 至 2023-12-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY Nearly 1 in 3 deliveries in the United States occurs by cesarean section, with unacceptable racial disparities impacting that rate. Protocols to standardize care have been shown to decrease adverse outcomes across medicine, including in obstetrics. In addition to improving outcomes overall, studies in non-obstetric populations have demonstrated that care standardization can considerably reduce racial disparities in health by reducing care variation, thereby minimizing the effects unconscious bias can have on decision-making. Labor induction, one of the most common procedures in obstetrics, varies widely in practice patterns by provider and site. Thus, we propose a novel means of reducing the cesarean rate, as well as racial disparities in obstetric outcomes: standardization of labor induction. The central hypothesis of this proposal is that a labor induction protocol will standardize the use of evidence-based active labor management practices in induction, thereby improving outcomes such as cesarean delivery rate, maternal morbidity, and neonatal morbidity. In addition, we believe our intervention will inhibit implicit bias from playing a significant role in labor management, thus specifically decreasing morbidity for Black women. This proposal will leverage mentorship of senior investigators (Drs. Parry and Levine) and Penn’s research programs in maternal fetal medicine, implementation science, biostatistics/epidemiology, and qualitative methods. We plan to test our hypothesis by studying the effectiveness of a standardized labor induction protocol, while simultaneously collecting process implementation data in a prospective cohort design. Aim 1 will compare obstetric outcomes two years pre- to two-years post-implementation of the labor induction protocol into routine care at two diverse sites. Aim 1A will determine if the induction protocol reduces racial disparities in these critical obstetric outcomes. Aim 2 will utilize the innovative mixed-methodologies of implementation science, underused to date in obstetrics, to understand acceptability, penetration, and fidelity surrounding the induction protocol. These data will aid in preparing our intervention for implementation in the national arena. Evaluation of the use of standardized labor induction protocol to reduce cesarean rate and eliminate racial disparities is a significantly important clinical question yet to be studied in the literature. Dr. Hamm is a maternal fetal medicine physician trained in clinical epidemiology with an established interest in implementation research. The training she proposes in designing effectiveness trials, the methodologies of implementation science, and leadership in healthcare innovation will enable her to become an independent researcher studying the implementation of large-scale, evidence-based initiatives in obstetrics. By the conclusion of this program, she will be able to independently design, enact, and evaluate interventions to reduce obstetric morbidity. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.

项目概要在美国，近三分之一的分娩是通过剖腹产进行的，种族差异令人无法接受事实证明，标准化护理方案可以减少不良后果。医学，包括产科，除了改善总体结果外，还对非产科人群进行研究。已经证明，护理标准化可以通过减少种族差异来显着减少健康方面的差异护理差异，从而最大限度地减少无意识偏见对决策的影响。引产是产科最常见的手术之一，其实践模式差异很大因此，我们提出了一种降低剖腹产率以及种族差异的新方法。产科结果：引产标准化该提案的中心假设是引产。引产协议将标准化在引产过程中基于证据的积极劳动管理实践的使用，改善剖宫产率、孕产妇发病率和新生儿发病率等结果。此外，我们相信我们的干预将抑制隐性偏见在劳动力中发挥重要作用管理，从而特别降低黑人女性的发病率。该提案将利用指导。高级研究人员（帕里博士和莱文博士）和宾夕法尼亚大学母胎医学研究项目，实施科学、生物统计学/流行病学和定性方法。我们计划通过研究标准化引产方案的有效性来检验我们的假设，同时在前瞻性队列设计中收集过程数据。比较引产方案实施前两年和实施后两年的产科结果目标 1A 将确定入院方案是否减少了种族差异。这些关键的产科结果将利用创新的混合实施方法。迄今为止在产科中尚未得到充分利用的科学，以了解围绕产科的可接受性、渗透性和保真度这些数据将有助于准备我们在全国范围内实施的干预措施。使用标准化引产方案降低剖宫产率和消除剖宫产率的评估种族差异是一个非常重要的临床问题，尚待文献研究。接受过临床流行病学培训的母胎医学医师对实施有明确的兴趣她提出的设计有效性试验和实施方法的培训。科学和医疗创新方面的领导力将使她成为一名独立研究员研究产科大规模、基于证据的举措的实施情况。计划中，她将能够独立设计、制定和评估干预措施，以减少产科拟议的 K23 的结果对于计划的 R01 级应用来说将是非常宝贵的试点工作。

项目成果

期刊论文数量（17）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Implementation and outcomes of a system-wide women's health 'team goal' to reduce maternal morbidity for black women: a prospective quality improvement study.

降低黑人妇女孕产妇发病率的全系统妇女健康“团队目标”的实施和结果：一项前瞻性质量改进研究。

DOI：
发表时间：
2022-11
期刊：
影响因子：
1.4
作者：
Hamm, Rebecca Feldman;Howell, Elizabeth;James, Abike;Faizon, Robert;Bloemer, Tina;Cohen, Jennifer;Srinivas, Sindhu K
通讯作者：
Srinivas, Sindhu K

An innovative sequential mixed-methods approach to evaluating clinician acceptability during implementation of a standardized labor induction protocol.

一种创新的顺序混合方法，用于评估临床医生在实施标准化引产方案期间的可接受性。

DOI：
发表时间：
2023-08-29
期刊：
影响因子：
4
作者：
Hamm, Rebecca Feldman;Levine, Lisa D;Szymczak, Julia E;Parry, Samuel;Srinivas, Sindhu K;Beidas, Rinad S
通讯作者：
Beidas, Rinad S

The impact on postpartum care by telehealth: a qualitative evaluation of the patient perspective.

远程医疗对产后护理的影响：对患者观点的定性评估。

DOI：
发表时间：
2023-11
期刊：
影响因子：
0
作者：
Arias, Maria Paula;Wang, Eileen Y;Leitner, Kristin;Sannah, Tasneem;Keegan, Morgan;DelFerro, Joseph;Iluore, Charissa;Hamm, Rebecca F
通讯作者：
Hamm, Rebecca F

Implementation of a calculator to predict cesarean delivery during labor induction: a qualitative evaluation of the clinician perspective.

实施计算器来预测引产期间剖宫产：临床医生观点的定性评估。