Medical Information Service via mobile Telephone (m-MIST TM) Provider Support to Improve Pregnancy Outcomes

通过移动电话 (m-MIST TM) 提供医疗信息服务以改善妊娠结果

基本信息

批准号：
10245295
负责人：
Henna Budhwani
金额：
$ 16.78万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
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 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10245295
关键词：
Address Adherence Administrator Advisory Committees Africa African Alabama Attention Back Baptist Church Cameroon Car Phone Caring Childhood Clinical Clinical Protocols Cluster randomized trial Consultations Country Data Development Discipline of obstetrics Effectiveness Ensure Equipment and Supplies Evaluation Exploration, Preparation, Implementation, and Sustainment Focus Groups Fostering Government Guidelines Health Health Services Health Services Accessibility Healthcare High-Risk Pregnancy Hospitals Hotlines Incidence Income Information Services Intervention Interview Life Location Low income Maternal Mortality Maternal-fetal medicine Measures Medical Medical emergency Methods Modeling Morbidity - disease rate Myeloma Proteins Neonatology Newborn Infant Organizational Models Outcome Ownership Patient Transfer Patients Perinatal Perinatal Care Perinatal mortality demographics Peripheral Phase Pregnancy Outcome Pregnant Women Prenatal care Primary Health Care Protocols documentation Provider Public Health Qualitative Methods Quality of Care Resources Rural Savings Services Societies Specialist Structure Support System Technology Telephone Testing Time Transportation United States Universities Use Effectiveness Woman World Health Organization acceptability and feasibility adverse maternal outcomes adverse pregnancy outcome authority barrier to care base care outcomes care providers care seeking care systems effectiveness evaluation effectiveness testing evidence base experience fetal global health health care availability implementation science improved improved outcome innovation low income country mHealth maternal outcome mobile computing multidisciplinary neonatal death perinatal outcomes point of care referral services research study satisfaction scale up service providers social structure standard of care sustainability framework symposium trial design

项目摘要

PROJECT SUMMARY Almost all maternal and perinatal deaths worldwide are in low-income countries (LICs). Delays in accessing and receiving appropriate quality pregnancy care, particularly during labor and delivery, is a major reason for these outcomes. Reducing adverse pregnancy outcomes is a current and high global priority. The University of Alabama at Birmingham's (UAB) maternal and fetal medicine and neonatology groups are the primary referral services for high-risk pregnancies and newborns statewide in underserved Alabama. Through UAB's highly valued, busy and pioneering toll-free 24/7 Medical Information Service via Telephone (MISTTM), timely, and often life-saving point-of-care consultation and guidance is available to rural providers caring for pregnant women and newborns. Although such provider support services are now part of standard-of-care in the United States, their implementation and assessment of that implementation are often unavailable in LICs with the worst maternal and perinatal outcomes. The rapid rise in mobile phone ownership in LICs provides a tremendous opportunity to adapt, implement, and evaluate innovative, potentially life-saving interventions such as MISTTM. The mobile platform can help mitigate structural barriers and enhance healthcare access needs of the patient by providing clinical support for remotely-located providers facing medical emergencies -- while also enhancing local care systems in resource-constrained settings. Thus, the purpose of this study is to adapt and evaluate the implementation of mobile-phone based MIST (mMIST) to improve maternal and newborn outcomes in a LIC. The proposed mMIST intervention will be adapted from our ongoing experience at UAB and implemented in Cameroon, which has the 9th highest maternal mortality ratio and one of the highest rates of perinatal mortality in the world. We propose three Specific Aims: 1) Adapt and develop a 24/7 mHealth support system for peripheral providers who provide healthcare to pregnant women and newborns; 2) Test mMIST's feasibility and acceptability in one health district in northwest Cameroon, and 3) Evaluate the effectiveness - using a stepped wedge cluster randomized trial design - of full-scale implementation of mMIST in reducing maternal and perinatal deaths, and serious maternal and newborn morbidities in 19 districts (clusters) of northwest Cameroon with 65,000 deliveries per year. A participatory approach involving stakeholders and a representative task force will inform the development and delivery of the intervention. Three frameworks will inform this study, WHO Model for Quality of Care, ADAPT-ITT for intervention adaptation, and the implementation science Exploration, Preparation, Implementation, Sustainment (EPIS) model. Additional features include plans to ensure sustainability by engaging the government and mobile service providers, and attention to m-health capacity building within this rigorous research study. If demonstrated effective, scaling-up the mMIST intervention will improve maternal and newborn outcomes across similar LIC settings.

项目概要全球几乎所有孕产妇和围产期死亡都发生在低收入国家 (LIC)。访问延迟接受适当的优质妊娠护理，特别是在临产和分娩期间，是这些结果。减少不良妊娠结局是当前全球的首要任务。大学阿拉巴马州伯明翰 (UAB) 母婴医学和新生儿学小组是主要转诊单位在服务不足的阿拉巴马州为全州范围内的高危妊娠和新生儿提供服务。通过UAB的高度有价值、繁忙且开创性的免费 24/7 电话医疗信息服务 (MISTTM)、及时且通常，照顾孕妇的农村提供者可以获得挽救生命的护理点咨询和指导妇女和新生儿。尽管此类提供者支持服务现已成为护理标准的一部分美国，他们的实施和对该实施的评估往往无法在产妇和围产期结局最差的低收入国家。低收入国家的手机拥有量迅速增加提供了一个巨大的机会来适应、实施和评估创新的、可能挽救生命的干预措施，例如 MISTTM。移动平台可以帮助减轻结构性障碍并增强通过为偏远地区的医疗服务提供者提供临床支持来满足患者的医疗保健访问需求医疗紧急情况——同时还加强资源有限地区的当地护理系统。因此，本研究的目的是调整和评估基于移动电话的 MIST (mMIST) 的实施，以改善低收入国家的孕产妇和新生儿结局。拟议的 mMIST 干预措施将根据我们的 UAB 持续积累的经验并在孕产妇死亡率排名第九的喀麦隆实施也是世界上围产期死亡率最高的国家之一。我们提出三个具体目标：1) 适应和为向孕妇提供医疗保健的外围提供商开发 24/7 移动医疗支持系统和新生儿； 2) 在喀麦隆西北部的一个卫生区测试 mMIST 的可行性和可接受性，以及 3) 使用阶梯式楔形聚类随机试验设计评估全面的有效性实施mMIST以减少孕产妇和围产儿死亡以及严重孕产妇和新生儿喀麦隆西北部 19 个地区（集群）的发病率每年达到 65,000 例。参与性涉及利益攸关方和代表性工作组的方法将为制定和交付提供信息的干预。三个框架将为这项研究提供信息：世界卫生组织护理质量模型、ADAPT-ITT 干预适应和实施科学探索、准备、实施、维持（EPIS）模型。其他功能包括通过参与确保可持续性的计划政府和移动服务提供商，以及在这一严格的框架内对移动医疗能力建设的关注研究性学习。如果证明有效，扩大 mMIST 干预将改善孕产妇和类似 LIC 环境中的新生儿结局。