Minding the gap: a multidisciplinary approach to reducing maternal health disparities in Georgia

关注差距：减少格鲁吉亚孕产妇健康差异的多学科方法

基本信息

批准号：
10263289
负责人：
ESTHER KATHLEEN ADAMS
金额：
$ 75.25万
依托单位：
EMORY UNIVERSITY
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：
2020-09-14 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10263289
关键词：
Adherence Admission activity Affect Birth Caring Case Management Case Manager Cessation of life Chronic Clinical Collaborations Communities Complex Computerized Medical Record Contraceptive methods Data Developed Countries Diabetes Mellitus Enrollment Ethnic Origin Ethnic group Evaluation Familiarity Family Planning Family Planning Programs Foundations Future Gestational Diabetes Guidelines Health Health Care Visit Health Personnel Health Services Research Health system Healthcare Healthcare Systems Hospitalization Hospitals Hypertension Improve Access Individual Institution Insurance Intervention Interview Knowledge Link Location Low income Maternal Health Maternal Health Services Maternal Mortality Medicaid Medical Methods Mind Minority Mothers Not Hispanic or Latino Obesity Outcome Outcome Assessment Outcome Measure Participant Pharmaceutical Preparations Policies Politics Postpartum Period Postpartum Women Pregnancy Pregnancy Complications Pregnant Women Prenatal care Prevalence Primary Health Care Process Measure Provider Race Randomized Records Research Resources Review Committee Risk Risk Factors Services Site Social support State Hospitals System Time Translating Uninsured Variant Very Low Birth Weight Infant Visit Woman Work adverse outcome base cardiometabolism cardiovascular risk factor care fragmentation care outcomes care systems design disparities in morbidity disparity reduction ethnic difference experience follow-up health care service utilization health disparity high risk hospital readmission improved inner city insight interdisciplinary approach maternal morbidity multidisciplinary outreach patient oriented postpartum care pregnancy hypertension prenatal preventable death preventive intervention programs racial and ethnic racial and ethnic disparities racial disparity randomized trial safety net severe maternal morbidity social social structure standard care standard of care success systematic review

项目摘要

PROJECT SUMMARY The US maternal mortality ratio (26.4 maternal deaths per 100,000 livebirths) is the highest among developed nations, with wide variation across states and racial/ethnic groups. The state of Georgia has the second highest maternal mortality (66.3 per 100,000), with a 60% higher rate for black vs white women (95.6 vs 59.7 per 100,000). Nearly 100 times more common than maternal mortality, however, is severe maternal morbidity (SMM). Maternal mortality and SMM are highest among women who are black, publicly insured or uninsured, and deliver in safety-net hospitals. In Georgia, nearly two-thirds of maternal deaths and SMM are deemed preventable, with chronic health conditions, obesity, delays in accessing and fragmentation of care as key contributors. Current data indicate that postpartum SMM is increasing at a faster rate than SMM during the delivery hospitalization. Proposed solutions to the maternal health crisis in Georgia include improved prenatal and postpartum follow-up and case management, control of chronic health conditions, and extension of Medicaid coverage. However, there is a dearth of evidence regarding whether such strategies can improve maternal health or reduce racial disparities in SMM or mortality. The proposed study will begin to fill this void with a multidisciplinary, mixed-methods approach. We will first analyze Georgia linked vital records, hospital discharge, and claims data to provide an overview of the extent, location and determinants of differences in SMM among non-Hispanic black and non-Hispanic white women at delivery and 3 to 12 months postpartum. Using regression-based decomposition methods we will highlight the portions of the racial/ethnic differences explained by observable and unobservable factors. We will use these findings and in-depth interviews with postpartum women and their health care providers and case managers to contextualize the analysis of two postpartum interventions targeting women at risk for adverse outcomes – an existing Medicaid policy and a newly designed health system intervention. The Georgia Medicaid Planning for Healthy Babies (P4HB) Medicaid program provides postpartum women with a very low birth weight delivery primary care inclusive of nurse case management and Resource Mother outreach to link women to social supports. This study will be the first to evaluate the effects of this Medicaid policy on SMM disparities. These analyses will then be used to inform the design of the new postpartum care system for women who deliver at a safety-net hospital in Atlanta, Georgia, and are at increased risk for SMM. Women (N = 320) will be randomly assigned to either this enhanced postpartum care system vs. standard care, with assessment of outcomes within 12 weeks and 12 months postpartum, including attendance of postpartum care visits, receipt of recommended care, and adverse outcomes such as hospital readmissions. The insights gained from the proposed work will fill critical knowledge gaps regarding policy and practice approaches for reducing maternal health disparities and can serve as a foundation for future prevention and intervention strategies within the state and nationally.

项目摘要在发达的国家和种族/族裔群体之间的差异很大。佐治亚州有第二个最高的孕产妇死亡率（每100,000每100,000），黑人与白人妇女的比率高60％（95.6 vs 59.7 每100,000）。然而，比产妇死亡率的近100倍是严重的母体发病率（SMM）。在黑人，公开保险或没有保险的女性中，孕产妇死亡率和SMM最高，并在安全网医院运送。在佐治亚州，将近三分之二的孕产妇死亡被认为是可以通过长期健康状况，肥胖，延迟访问和分散护理作为关键贡献者。当前数据表明产后SMM的增长速度比SMM更快分娩住院。佐治亚州孕产妇健康危机的拟议解决方案包括改善产前以及产后随访和病例管理，慢性健康状况的控制以及扩展医疗补助覆盖范围。但是，关于此类策略是否可以改善的证据死亡孕产妇健康或减少SMM或死亡率的种族分布。拟议的研究将开始填补这一空白采用多学科的混合方法方法。我们将首先分析佐治亚州链接的重要记录，医院并索赔数据，以概述范围，位置和确定的差异非西班牙裔黑人和非西班牙裔白人妇女的SMM和产后3到12个月的SMM。使用基于回归的分解方法，我们将重点介绍种族/种族差异的部分用可观察和不可观察的因素解释。我们将使用这些发现和深入的访谈产后妇女及其医疗保健提供者和案例经理，以将两个人的分析背景化产后干预措施针对有不良后果危险的妇女 - 现有的医疗补助政策和新设计的卫生系统干预。佐治亚州健康婴儿的医疗补助计划（P4HB）医疗补助计划为产后妇女提供非常低的出生体重提供初级保健，包括护士案件管理和资源母亲的宣传，将妇女与社会支持联系起来。这项研究将是第一个评估该医疗补助政策对SMM分布的影响的人。这些分析将用于告知在亚特兰大一家安全网医院分娩的新的产后护理系统的设计佐治亚州，SMM的风险增加。妇女（n = 320）将随机分配给这两个增强的产后护理系统与标准护理，并在12周内评估结果和12 产后月份，包括产后护理访问，推荐护理和逆境医院再入院等结果。从拟议的工作中获得的见解将填补关键知识有关减少母性健康差异的政策和实践方法的差距，并可以作为国家和国家内部预防和干预策略的基础。