Strengthening perinatal healthcare utilization and quality of care for Indigenous and low socioeconomic status women through systems change: integrating person, provider, and policy perspectives.

通过系统变革，加强对土著和低社会经济地位妇女的围产期保健利用和护理质量：整合个人、提供者和政策观点。

• 批准号: 10748659
• 负责人: Arielle R. Deutsch
• 金额: $ 57.07万
• 依托单位: AVERA MCKENNAN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748659
• 关键词: Accounting; Address; Advocate; Affect; American Indians; Area; Automobile Driving; Biological Models; Childbirth; Collaborations; Communities; Community Health; Complement; Complex; Country; Data; Decision Making; Disparity; Ecosystem; Equity; Evaluation; Failure; Geography; Goals; Health; Health Policy; Health system; Healthcare; Healthcare Systems; Human Resources; Indigenous; Individual; Inequity; Literature; Maternal Health; Mediation; Minority Groups; Modeling; Network-based; Outcome; Pathway Analysis; Pathway interactions; Patients; Perinatal; Perinatal Care; Persons; Policies; Population; Pregnancy; Process; Provider; Quality of Care; Recommendation; Research; Research Personnel; Reservations; Resource-limited setting; Resources; Role; Rural Community; Sampling; Science; Services; Structural Racism; Surveys; System; Testing; Translating; United States Public Health Service; Woman; Women Status; disparities in morbidity; disparity reduction; dynamic system; experience; health care quality; health care service utilization; health equity; improved; in silico; interest; low socioeconomic status; marginalized population; maternal morbidity; member; models and simulation; perinatal health; postnatal period; predictive modeling; prenatal; social health determinants; success

PROJECT SUMMARY The goal of this project is to identify high-efficacy and actionable strategies to improve perinatal healthcare utilization and perinatal healthcare quality (perinatal care utilization and quality; PCUQ) and reduce maternal morbidity (MM) rates and disparities experienced by for American Indian (AI) and low socioeconomic status women within a Northern Plains area. High rates of MM and disproportionate burden of MM experienced by marginalized groups has resulted in a wide range of recommendations to improve maternal health. Many recommendations focus on reducing barriers and enhancing facilitators (B/F) that will increase utilization of perinatal care or will improve the quality of perinatal care provided. However, there is little understanding of which B/F have the strongest impact on PCUQ and are therefore the most effective targets to improve PCUQ across the spectrum of person/patient, provider/health system and policy levels. This understanding is critical for actions that will reduce MM, as the association between PCUQ and MM is still unclear. Recommendations also rarely account the unique contexts of both cultural strengths as facilitators and systemic/structural racism as barriers experienced by AI communities, or contexts that impact the feasibility and success of implementing specific changes. To address these issues, this project involves building a community-based system dynamics simulation model that will detail the PCUQ B/F on person/patient, provider/health system and policy levels driving low PCUQ rates and disparities for AI and low socioeconomic status women (Aim 1). Models will be developed using a community-based participatory approach in collaboration with stakeholders who have personal and professional experience in the multiple components of PCUQ. This model will be simulated, and community-informed hypotheses will be tested to identify which B/F should be targeted as the best strategies for improving PCUQ and reducing disparity. Simulation models will be created in part with survey data from 380 women (65% AI) who live within the target communities and have had recent pregnancy and/or childbirth experience. This data will also be used to estimate path models that will evaluate PCUQ B/F as indirect effects on MM (Aim 2). Finally, we will develop qualitative community- based system dynamics models detailing the process of mechanisms that drive decision making and implementing actions for changes to perinatal healthcare practice and policy and the role of research during these processes (Aim 3). Models will be developed in collaboration with a sample of health system and policy decisionmakers and stakeholders, and with a sample of grassroots advocates for AI health and health equity to further evaluate equity or inequity within decision making and change processes. Key mechanisms for change and equity will be identified through network-based analysis of the qualitative model. The three studies detailed within this project will cumulatively critical information to improve maternal health and health equity for AI and low socioeconomic status women in a high need region, as well as a clear pathway for how this information should be utilized to implement the action plan that will be developed using project findings in collaboration with community stakeholders and collaborators.

项目概要 该项目的目标是确定高效且可行的策略，以提高围产期医疗保健的利用率 和围产期医疗保健质量（围产期保健利用率和质量；PCUQ）并降低孕产妇发病率 (MM) 以及北部平原地区美洲印第安人 (AI) 和社会经济地位较低的妇女所经历的差异 区域。 MM 发病率高以及边缘化群体承受的MM 负担过大，导致了广泛的 一系列改善孕产妇健康的建议。许多建议侧重于减少障碍和 加强促进者（B/F），以提高围产期护理的利用率或提高围产期护理的质量 假如。然而，人们对哪一个 B/F 对 PCUQ 影响最大、因此是最重要的 B/F 知之甚少。 在个人/患者、提供者/卫生系统和政策方面改善 PCUQ 的最有效目标 水平。这种理解对于减少 MM 的行动至关重要，因为 PCUQ 和 MM 之间的关联仍然存在 不清楚。建议也很少考虑到作为促进者和促进者的文化优势的独特背景。 系统性/结构性种族主义是人工智能社区遇到的障碍，或影响可行性和成功的背景 实施具体变革。为了解决这些问题，该项目涉及构建一个基于社区的系统 动态模拟模型将详细介绍个人/患者、提供者/卫生系统和政策级别的 PCUQ B/F 推动低 PCUQ 率以及人工智能和低社会经济地位女性的差异（目标 1）。将开发模型 与具有个人和专业知识的利益相关者合作，采用基于社区的参与方法 PCUQ 多个组成部分的经验。该模型将被模拟，社区知情的假设将被验证 进行测试以确定哪个 B/F 应作为改善 PCUQ 和减少差异的最佳策略。 模拟模型的创建部分将采用来自目标范围内 380 名女性（65% AI）的调查数据 社区并最近有过怀孕和/或分娩经历。该数据还将用于估计路径 将评估 PCUQ B/F 作为对 MM 的间接影响的模型（目标 2）。最后，我们将发展优质社区—— 基于系统动力学模型，详细描述了驱动决策和实施的机制过程 采取行动改变围产期保健实践和政策以及研究在这些过程中的作用（目标 3）。 将与卫生系统和政策决策者及利益相关者的样本合作开发模型， 并收集人工智能健康和健康公平的草根倡导者样本，以进一步评估内部的公平或不平等 决策和变更过程。将通过基于网络的方式确定变革和公平的关键机制 定性模型分析。该项目中详述的三项研究将累积关键信息 改善高需求地区人工智能和低社会经济地位妇女的孕产妇健康和健康公平，以及 明确如何利用这些信息来实施将使用以下方法制定的行动计划： 与社区利益相关者和合作者合作的项目结果。