Complex Systems Approaches to Advance Maternal Health Disparities Research and Prevention: Developing a System Dynamics Simulation Model of Severe Maternal Morbidity among Black Women

促进孕产妇健康差异研究和预防的复杂系统方法：开发黑人妇女严重孕产妇发病率的系统动力学模拟模型

• 批准号: 10658690
• 负责人: Kyrah K Brown
• 金额: $ 36.51万
• 依托单位: UNIVERSITY OF TEXAS ARLINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-26 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658690
• 关键词: Address; Area; Calibration; Childbirth; Clinical; Communities; Complex; Coupled; Data; Data Set; Decision Making; Development; Discipline; Disparity; Distal; Economics; Effectiveness; Effectiveness of Interventions; Elements; Equity; Feedback; Fostering; Health; Health Disparities Research; Health Status; Healthcare; Individual; Intervention; Knowledge; Learning; Life Cycle Stages; Literature; Maternal Health; Maternal Mortality; Methodology; Methods; Modeling; Municipalities; Not Hispanic or Latino; Outcome; Participant; Pathway interactions; Prevention; Prevention strategy; Process; Public Health; Race; Research; Research Methodology; Research Personnel; Risk Factors; Science; Shapes; Social Policies; Societies; Structural Racism; System; Testing; Texas; Time; Translating; United States; Validation; Woman; black women; dashboard; disparities in morbidity; disparity reduction; dynamic system; economic determinant; effectiveness evaluation; evidence base; health determinants; health disparity; insight; maternal risk; metropolitan; model building; models and simulation; novel; population health; racial discrimination; severe maternal morbidity; simulation; social; social determinants; tool; web site

PROJECT SUMMARY Non-Hispanic Black women (NHBW) are twice as likely as NH White women to suffer SMM, which in- creases risk for maternal mortality. Although the clinical cause of SMM is multifactorial, the disparity is driven by structural racism. Despite the breadth of knowledge and existing preventive strategies, prolonged SMM dis- parities suggest that current efforts alone are insufficient to achieve equity. Thus, alternate approaches are needed to transform understanding of the causes of SMM disparities and to generate breakthroughs in preven- tion. We argue that SMM disparities are best conceptualized as dynamically complex systems, consisting of tightly coupled elements that continually evolve over time. Thus, to address SMM disparities among NHBW, we will apply complex systems approaches – namely, system dynamics (SD) modeling and system dynamics group model building (SD GMB) – to answer complexity-informed research questions and enable more effica- cious prevention strategies. The overall aim of this project is to apply complex systems approaches to generate a holistic under- standing of the dynamically complex systems underlying SMM outcomes among NHBW, and then translate this understanding into a novel, evidence-based simulation model to be used for evaluating the effectiveness of interventions that can curb SMM outcomes among NHBW. Our specific aims are as follows: 1) to use SD GMB to create a qualitative SD model of the dynamically complex systems that generate SMM outcomes among NHBW; 2) to translate the qualitative SD model into a quantitative SD simulation model; 3) to identify, evaluate, and enhance the effectiveness of existing and plausible interventions that can reduce disparate SMM outcomes among NHBW; and 4) to disseminate the quantitative SD model as a simula- tion-based dashboard for stakeholders and researchers aiming to reduce SMM outcomes among NHBW. The successful completion of this project is expected to transform understanding of the development and perpetuation of SMM disparities by: a) using systems science methods to identify effective solutions to re- duce racial gaps in health; b) disseminating insights to diverse stakeholders to guide broader community- level healthcare and social policy decision-making in the presence of dynamic complexity; and c) providing an initial SD model of maternal health disparities that can spur replication across other contexts. This project will also impact health disparities research more broadly by: a) demonstrating the potential of convening di- verse perspectives in maternal health, complex systems science, and participatory research methods in health disparities research; b) providing transformative evidence of the utility of complex systems approaches in maternal health disparities research and prevention; and c) generating the first SD model of SMM dispari- ties that can be expanded or adapted to other contexts (e.g. as a national model), with anticipated and plau- sible impacts for the broader public and population health fields and related disciplines.

项目摘要 非西班牙裔黑人妇女（NHBW）的可能性是NH白人妇女的两倍，这是 孕产妇死亡率的风险。 通过结构性种族主义。 奇偶表明，仅当前的努力才能达到公平。 需要改变对SMM差异原因的理解，并在预见中产生抚养 我们认为，SMM差异最佳地概念化为动态复杂的系统 随着时间的流逝，持续发展的元素紧密地解决了NHBW之间的SMM差异 我们将应用复杂的系统方法 - 即系统动力（SD）建模和系统动力学 小组模型构建（SD GMB） - 回答复杂性的研究问题，并使更具效率 预防策略。 总体目的 NHBW中SMM结果的动态复杂系统的站立和Theen 将这种理解转化为一种新型的基于证据的仿真模型，用于评估 可以遏制NHBW中SMM结果的干预措施的有效性。 以下内容：1）使用SD GMB创建生成动态复杂系统的定性SD模型 NHBW中的SMM结果；将定性SD模型转换为定量SD模拟 模型; 3）识别，评估和增强现有和合理的干预措施 减少NHBW中的不同SMM结果； 旨在减少NHBW中SMM成果的基于基于利益持有人的仪表板。 成功完成了发展发展发展的发展 SMM差异的持续性：a）使用系统科学方法来识别有效的解决方案以重新 在健康方面的种族差距； 在有动态复杂性的情况下，级别的医疗保健和社会政策决策； 孕产妇健康差异的初始SD模型，可以刺激其他环境。 还将影响健康差异的研究更广泛：a）证明召集的潜力 孕产妇健康，复杂系统科学和参与研究方法的诗歌观点 健康差异研究； 在孕产妇健康差异研究和预防中） 可以扩展或适应其他情况的联系（例如，作为国家模型），并具有预期和plau- 对更广泛的公共和人口健康领域以及相关学科的影响。