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).

随着非洲预期寿命的延长，怀孕已成为一种新出现的危及生命的并发症 在低收入和中等收入国家，SCD 妇女的孕产妇死亡比值与 SCD 相关。 为 22.81，95% CI 14.67–35.46.1 2012-2014 年，Korle-Bu 教学医院产科 加纳阿克拉的 KBTH 建立了一个由产科医生领导的 SCD 产科 (OB) 诊所。 这三年（2012 年至 2014 年）的 SCD 死亡率约为 12%，2015 年 1 月， 多学科SCD OB团队成立，该团队进行了联合回顾性/前瞻性的研究。 KBTH 七年来（2010-2016 年）所有 SCD 妇女孕产妇死亡病例系列。2 回顾性数据收集凸显了急性胸部护理的失败和挑战。 急性疼痛发作之前出现的综合症是近 87% 女性死亡的主要原因。2 2015年5月，团队实施产科/血液科联合门诊，建立母婴密切监护 此外，SCD OB 团队还建立了一个临床指导方针/方案。 每周沟通系统来裁决具有挑战性的案件的管理。 孕产妇死亡率风险降低了 89.1%（从每 100,000 名活产婴儿 10,791 人死亡降至 1,176 人）； p=0.007) 超过 13 个月。3 自从启动我们的多学科 SCD OB 计划以来，我们始终如一 与团队之前相比，该队列中的孕产妇死亡率降低了约 90% 已建立。4,5 这个由医生指导的应用程序旨在进行有效性实施 可行性研究将我们降低孕产妇死亡率的结果从学术医院推广到非学术医院 加纳阿克拉的学术医院目前孕产妇死亡率为 5,940 人/100,000 人 SCD 妇女的活产 在五年内，申请人将获得使用综合的技能。 实施研究框架 (CFIR)6 和 RE-AIM 框架（覆盖范围、有效性、 采用、实施和维护）7 告知研究的各个阶段，申请人将测试该研究。 假设“在研究设计之前和之后，申请人将检验以下假设： 在非学术医院对患有 SCD 的孕妇进行纪律护理和任务转移将 与同一医院之前的死亡率相比，死亡相对风险降低了 80% 多学科医疗保健。”该指导奖项的具体目标是：1) 确定背景 影响循证实践适应性的决定因素（障碍/促进因素） 建立多学科 SCD OB 团队作为非学术医院的干预措施，包括 实施过程（第 1-2 年）；2) 在非非学科领域培养多学科 SCD OB 计划的能力 学术医院（第 3-5 年），以及 3) 进行混合 1 型可行性研究，比较有效性 非学术场所的任务转移多学科 SCD OB 计划（3-5 年）。