Living Healthy for Moms

为妈妈们健康生活

• 批准号: 10748870
• 负责人: Lauren M Osborne
• 金额: $ 96.05万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 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/10748870
• 关键词: Address; Adopted; Adoption; Advocacy; Age; Behavior Therapy; Behavioral; Birth; Black race; Breast Feeding; Cardiovascular system; Caribbean region; Caring; Client satisfaction; Clinical; Cognitive; Cognitive Therapy; Collaborations; Communities; Community Health Aides; Community Hospitals; Competence; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Detection; Dimensions; Disadvantaged; E-learning; Ecosystem; Electronic Health Record; Emergency Situation; Event; Evidence based intervention; Focus Groups; Goals; Health; Health Personnel; Health system; Healthcare; Home Blood Pressure Monitoring; Hospital Administrators; Hospitals; Hybrids; Incidence; Individual; Infrastructure; Intervention; Interview; Learning; Life; Low income; Maternal Health; Maternal Mortality; Maternal health equity; Measures; Medical; Mental Health; Methods; New York; New York City; Overdose; Parents; Participant; Patients; Perinatal; Personal Satisfaction; Persons; Physiological; Population; Postpartum Depression; Postpartum Period; Pregnancy; Process Measure; Provider; Psyche structure; Quality of Care; Quality of life; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research Personnel; Resources; Risk; Services; Site; Social support; Suicide; Surveys; System; Telephone; Testing; Thinking; Training; Trauma; Update; Visit; Weather; Women' s Health; Work; allostatic load; attentional control; behavioral health intervention; cardiovascular health; cardiovascular risk factor; comorbidity; effectiveness evaluation; effectiveness measure; effectiveness testing; empowerment; ethnic minority; evidence base; experience; health care service utilization; health equity; hospital services; implementation framework; implementation outcomes; implementation process; implementation strategy; implementation trial; improved; innovation; integrated care; intervention participants; intervention refinement; intrapartum; novel; perceived stress; physical conditioning; policy implication; postpartum care; postpartum health; postpartum outcome; prevent; primary outcome; programs; racial minority; resilience; satisfaction; scale up; social; substance use; theories; training opportunity; treatment arm

PROJECT 2: PROJECT SUMMARY/ABSTRACT Most preventable maternal deaths occur in the intrapartum and immediate postpartum (PP) periods, as do complications from undetected/undertreated mental health (MH) conditions (e.g., suicide, overdose) and cardiovascular (CV) events. In New York City (NYC), maternal deaths are 8–12 times higher for Black than for White birthing parents. However, most community-based programs addressing the health of birthing individuals in this population have been narrowly focused on basic services (e.g., breastfeeding, social support), with limited focus on evidence-based care. Holistic interventions addressing physical, mental, and social health needs in the critical PP transition and moving from trauma- and “risk”-based to a strength- and empowerment-based approach are urgently needed. Many hospital, community, and governmental barriers preclude broad adoption and scaling of doula-delivered care, and it is not known how facilitators, assets, and resources can improve care continuity and community-hospital linkages to support birthing individuals at diverse sites across NYC. The impact of doula- led interventions at patient- and health-system levels have yet to be rigorously evaluated. In collaboration with the Caribbean Women's Health Association and the Northern Manhattan Perinatal Partnership, we will address these gaps by implementing and evaluating Living Healthy for Moms (LHMoms) in three complementary settings and populations (Brooklyn, Queens, and Northern Manhattan). LHMoms is a novel integrated care intervention that focuses intensively on care continuity and community-to-healthcare linkages that starts prior to discharge and during the first 7 days post-discharge (PD) and extends into six months post-partum, as critical windows to prevent long-term physical and mental health sequelae, while also addressing key determinants of lifelong health risk. We have developed several innovative, evidence-based interventions, including an online education empowerment program (using a Patient Activated Learning System platform we developed) to build patient self- advocacy beginning in-hospital; a doula-led health emergency detection program during the critical first 7 days PD; and a trauma-informed doula-delivered cognitive behavioral phone intervention to address PP depression and cardiovascular risks for the critical six months following delivery. We propose a rigorous, mixed-methods study of LHMoms to address three specific aims. In Aim 1, we will test the effectiveness of LHMoms vs. attention control in a Hybrid Type 1 Implementation Trial with 450 randomized birthing individuals at three hospital sites in Brooklyn, Queens, and Northern Manhattan. This will include refining and tailoring the intervention to each site to maximize care quality, building capacity for doulas to deliver LHMoms, and assessing effectiveness in lowering PP depression, improving CV health, and creating better quality of life. In Aim 2, we will analyze the effects of LHMoms on PP healthcare utilization and satisfaction. In Aim 3, we will examine the implementation process and outcomes of the LHMoms intervention at the three sites. This project will advance the overall goals of NY-CHAMP to optimize PP outcomes for historically disadvantaged birthing individuals.

项目2：项目摘要/摘要 最可预防的孕产妇死亡发生在产后和产后（PP）时期， 未发现/未发现/未经发现的心理健康（MH）条件（例如自杀，用药过量）和的并发症 心血管（CV）事件。在纽约市（纽约），黑人的死亡人数比 白色生日父母。但是，大多数基于社区的计划涉及生日个人的健康 在这个人群中，人们一直专注于基本服务（例如，母乳喂养，社会支持），有限 专注于循证护理。全面干预措施，以满足身体，心理和社会健康需求 关键的PP过渡和从创伤和“风险”转变为基于力量和赋权的方法 迫切需要。许多医院，社区和政府障碍排除广泛采用和扩展 杜拉（Doula）交付的护理，尚不知道促进者，资产和资源如何改善护理连续性 和社区医院的联系，以支持纽约市各地的分娩个人。 Doula-的影响 患者和健康系统水平的LED干预措施尚未严格评估。与 加勒比妇女健康协会和曼哈顿北部围产期伙伴关系，我们将讨论 这些差距通过在三个完整的环境中实施和评估妈妈（LHMOMS）的健康生活 和人口（布鲁克林，皇后区和曼哈顿北部）。 LHMOMS是一种新颖的综合护理干预措施 这强烈着重于出院前开始的护理连续性和社区对健康链接 在入院后的头7天（PD）中，并延伸到后六个月，作为关键窗户 防止长期身心健康后遗症，同时解决关键的确定终身健康 风险。我们已经开发了几种创新的，基于证据的干预措施，包括在线教育 授权计划（使用我们开发的患者激活学习系统平台）来建立患者自我 倡导开始院内；在关键的前7天，由杜拉领导的健康紧急检测计划 PD;以及一种信息的杜拉（Doula）延长的认知行为手机干预，以解决PP抑郁症 分娩后六个月的关键风险和心血管风险。我们提出了一个严格的混合方法 LHMOM的研究以解决三个具体目标。在AIM 1中，我们将测试LHMOMS与注意力的有效性 在三个医院现场的450个随机生日个人的混合动力1型实施试验中的控制 在布鲁克林，皇后区和曼哈顿北部。这将包括精炼和调整每个人的干预措施 站点以最大化护理质量，建立导Doulas提供LHMOM的能力，并评估有效性 降低PP抑郁症，改善简历健康并创造更好的生活质量。在AIM 2中，我们将分析 LHMOM对PP医疗保健利用和满意度的影响。在AIM 3中，我们将检查实施 LHMOMS干预在三个地点的过程和结果。该项目将促进总体目标 纽约州立大学（NY-CHAMP），以优化历史上受不安的生日个人的PP成果。