Equity in Obstetrics: Reducing disparities in rates of cesarean birth and cesarean-linked hemorrhages

产科公平：减少剖宫产率和剖宫产相关出血率的差异

• 批准号: 10748638
• 负责人: Elliott K Main
• 金额: $ 55.44万
• 依托单位: STANFORD UNIVERSITY
• 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/10748638
• 关键词: Address; Birth; Black Populations; California; Caring; Cesarean section; Clinical; Collection; Communities; Community Health; Community of Practice; Complement; Complex; Data; Data Set; Discipline of obstetrics; Disparity; Equity; Ethnic Origin; Evaluation; Hemorrhage; Hospitals; Individual; Inequity; Institution; Intervention; Interview; Language; Life; Link; Maternal Health; Measures; Methods; Morbidity - disease rate; Outcome; Outpatients; Patients; Performance; Persons; Population; Postpartum Hemorrhage; Postpartum Period; Process; Provider; Public Health; Qualitative Methods; Quality of Care; Race; Reporting; Research; Resources; Risk; Structure; Surveys; System; Time; Translating; United States; Vaginal delivery procedure; Validation; Voice; Woman; Work; black women; clinical practice; cultural equity; data centers; disparity elimination; disparity reduction; effectiveness analysis; effectiveness evaluation; experience; high risk; implementation strategy; improved; insight; maternal outcome; microaggression; mortality; novel; obstetric care; patient oriented; payment; people of color; postpartum morbidity; prevent; prospective; racism; response; severe maternal morbidity; tool; web site

Project Summary/Abstract: Project 2 Almost 1 in 3 births in the United States involves cesarean delivery. A lifesaving intervention when appropriate, cesarean is associated with significant risks that include severe postpartum hemorrhage and severe maternal morbidity (SMM). Compared to vaginal delivery, women undergoing cesarean delivery incur the highest risk of postpartum hemorrhage and hemorrhage-related morbidity. In the last 30 years, significant disparities in rates of cesarean birth have developed for Black women, disparities that elevate their risks of morbidity from hemorrhage and mortality. Reducing cesarean rates is therefore essential for reducing postpartum hemorrhage and postpartum-related SMM. Eliminating disparities in cesarean delivery requires multifaceted, multilevel interventions that can be deployed at scale. We will build on our expertise in achieving population-level improvements in maternal outcomes (including hemorrhage and cesarean delivery) and long-standing collaborative partnerships with patients, communities, and public health agencies to identify and implement strategies to reduce disparities in cesarean birth and hemorrhage. Our state-wide quality improvement network with a sophisticated real-time data center will enable us to support complex equity interventions and track improvement. Capitalizing on our collaborative network of 218 hospitals covering 99% of births in CA, we will realize the following Specific Aims: (1) Use mixed method approaches to identify strategies to reduce disparities in rates of cesarean birth and cesarean-associated hemorrhages. (2) Center patient voices in the validation and continuous curation of action tools and resources that will be integrated into a Maternal Equity Guide, a toolkit of resources to drive equity change within hospitals. (3) Expand implementation of the Maternal Equity Guide in state-wide efforts to reduce disparities. (4) Assess effectiveness of the Maternal Equity Guide tools/resources and implementation strategies. We collect real-time patient-level data for all California births including patient-identified race and ethnicity allowing us to measure changes in multiple maternal health outcomes at state, hospital, and even provider levels. Combined with qualitative methods, this will provide a particularly robust analysis of effectiveness of our interventions. Results will establish a national roadmap for effectively integrating equity into large-scale quality improvement to address disparities in rates of cesarean births with potential application to other aspects of obstetric care.

项目摘要/摘要：项目2 在美国，几乎有三分之一的出生涉及剖宫产。适当的救生干预措施， 剖宫产与重大风险有关，包括严重的产后出血和严重的母体 发病率（SMM）。与阴道分娩相比，经历剖宫产的妇女受到最高风险 产后出血和出血相关的发病率。在过去的30年中，利率差异很大 剖宫产的出生是为黑人妇女发展的，这些差异提高了其发病率的风险 出血和死亡率。因此，降低剖宫产对于减少产后出血至关重要 和产后相关的SMM。消除剖腹产的差异需要多方面的多层次 可以大规模部署的干预措施。我们将基于我们实现人口级的专业知识 孕产妇结局的改善（包括出血和剖宫产）和长期存在 与患者，社区和公共卫生机构的合作伙伴关系，以识别和实施 减少剖宫产和出血差异的策略。我们全州范围的质量改进网络 借助复杂的实时数据中心，我们能够支持复杂的公平干预措施并跟踪 改进。利用我们的218家医院的合作网络，覆盖CA的99％的出生，我们将 实现以下特定目的：（1）使用混合方法来识别减少策略 剖宫产和剖宫产相关出血的差异。 （2）中心患者的声音 验证和持续的策划行动工具和资源将集成到孕产妇资产中 指南，用于推动医院股权变更的资源工具包。 （3）扩大产妇的实施 全州范围内努力减少差异的努力指南。 （4）评估孕产妇资产指南的有效性 工具/资源和实施策略。我们收集所有加利福尼亚出生的实时患者级数据 包括患者识别的种族和种族，使我们能够衡量多种母性健康的变化 州，医院甚至提供者水平的结果。结合定性方法，这将提供 特别是对干预措施有效性的强大分析。结果将建立一个国家路线图 有效地将股权整合到大规模质量改进中，以解决剖宫产差异的差异 出生潜在地应用于产科护理的其他方面。