Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

斯坦福大学 PRIHSM：预防与出血相关的严重孕产妇发病率的不平等

基本信息

批准号：
10748636
负责人：
SUZAN L CARMICHAEL
金额：
$ 212万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
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/10748636
关键词：
Address Admission activity Affect Anemia Asian Asian population Attention Birth Black Populations Black race California Caring Centers of Research Excellence Cesarean section Clinical Collaborations Communities Complex Diagnosis Dimensions Discipline Discipline of obstetrics Disparity Emotional Environment Equity Ethnic Origin Evaluation Goals Healthcare Hemorrhage High Prevalence Hospitalization Hospitals Incidence Individual Inequity Intervention Iron deficiency anemia Latinx Latinx population Leadership Life Cycle Stages Link Location Maternal Health Maternal Mortality Maternal health equity Mental Health Methods Morbidity - disease rate Mothers Native Americans Outcome Patients Persons Play Population Population Heterogeneity Positioning Attribute Post-Traumatic Stress Disorders Postpartum Depression Postpartum Hemorrhage Postpartum Period Pregnancy Prevalence Prevention Prevention strategy Provider Race Research Research Infrastructure Rest Risk Risk Factors Role Science Standardization Training Translating Universities Work antenatal community involvement disparity elimination disparity reduction effective therapy ethnic disparity experience health equity high risk improved innovation intrapartum marginalized population mortality multidisciplinary post-traumatic stress post-traumatic symptoms postpartum health prevent prospective racial disparity severe maternal morbidity social social structure training opportunity treatment strategy underserved area

项目摘要

Project Summary: Overall Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) and disproportionately affects socially marginalized groups. We propose to create a Maternal Health Research Center of Excellence at Stanford University called PRIHSM (PReventing Inequities in Hemorrhage-related Severe Maternal morbidity). The goals of PRIHSM are to reduce PPH and associated SMM by reducing and addressing disparities in important precursors to PPH-related SMM and mortality: cesarean birth and iron deficiency anemia (IDA). The problem of maternal IDA is vastly under-appreciated yet it affects approximately 16% of pregnancies in the U.S.; rates are 3-4x higher among Black people and 1.5-2x higher among Latinx people compared to the rest of the population. This translates to higher rates of PPH-related SMM. We propose that by effectively addressing antenatal IDA and these disparities, we can reduce PPH-related SMM. Additionally, almost 1 in 3 U.S. births are by cesarean delivery, rates vary 10-fold across hospitals, and Black and Asian individuals have the highest prevalence of cesarean section among low-risk pregnancies. While cesarean section can be a lifesaving intervention when appropriate, it is associated with significant risks that include PPH. We propose that enhanced birth equity and reduced variability in obstetric management are important strategies in addressing disparities in cesarean-linked PPH and reducing PPH-related SMM. Thus, our Aims are to: Aim 1 (Project 1). Reduce antenatal IDA by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit, which will standardize the evaluation, diagnosis, and treatment of IDA and reduce the prevalence of IDA and racial/ethnic disparities in IDA at birth admission and PPH-associated SMM. Aim 2 (Project 2). Reduce disparities in rates of primary cesarean birth and cesarean-linked PPH by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. Our work will involve community-university partnerships focused on improving maternal health equity and be driven by perspectives of patients, providers, and healthcare leadership. Our work will provide training opportunities to build research and clinical expertise relevant to PPH, especially among individuals who represent diverse perspectives and experiences within academic and community-based settings, and underserved areas. We propose a bold yet achievable agenda that will affect a sustainable decline in PPH-related mortality and morbidity and disparities.

项目概要：总体产后出血 (PPH) 是孕产妇死亡和严重孕产妇发病 (SMM) 的主要原因，并且对社会边缘群体影响尤为严重。我们建议在斯坦福大学创建一个孕产妇健康卓越研究中心，称为 PRIHSM（预防出血相关严重孕产妇发病率的不平等）。 PRIHSM 的目标是通过减少和解决与 PPH 相关的 SMM 和死亡率的重要前兆：剖宫产和缺铁性贫血 (IDA) 之间的差异，来减少 PPH 和相关的 SMM。孕产妇 IDA 问题并未得到充分重视，但它影响着美国约 16% 的妊娠；与其他人群相比，黑人的发病率高出 3-4 倍，拉丁裔的发病率高出 1.5-2 倍。这意味着与 PPH 相关的 SMM 发生率更高。我们建议，通过有效解决产前 IDA 和这些差异，我们可以减少与 PPH 相关的 SMM。此外，美国近三分之一的新生儿是通过剖腹产分娩的，不同医院的剖腹产率相差十倍，而且黑人和亚洲人在低风险妊娠中剖腹产率最高。虽然剖宫产在适当的情况下可以是一种挽救生命的干预措施，但它也与包括产后出血在内的重大风险相关。我们认为，提高出生公平性和减少产科管理的变异性是解决剖宫产相关 PPH 差异和减少 PPH 相关 SMM 的重要策略。因此，我们的目标是：目标 1（项目 1）。通过开发、实施和传播患者知情的贫血预防工具包来减少产前 IDA，该工具包将标准化 IDA 的评估、诊断和治疗，并减少 IDA 的患病率以及入院时 IDA 和 PPH 相关的种族/民族差异SMM。目标 2（项目 2）。通过进行混合方法研究以了解医院层面差异的驱动因素，并实施患者知情的孕产妇公平指南，减少初次剖宫产率和剖宫产相关产前出血率的差异。我们的工作将涉及社区与大学的合作伙伴关系，重点是改善孕产妇健康公平性，并由患者、提供者和医疗保健领导层的观点驱动。我们的工作将提供培训机会，以建立与 PPH 相关的研究和临床专业知识，特别是在学术和社区环境以及服务不足的领域代表不同观点和经验的个人。我们提出了一个大胆但可实现的议程，该议程将影响 PPH 相关死亡率、发病率和差异的可持续下降。