RP2_Harville

RP2_哈维尔

基本信息

批准号：
10749377
负责人：
Emily Wheeler Harville
金额：
$ 86.1万
依托单位：
TULANE UNIVERSITY OF LOUISIANA
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/10749377
关键词：
Address Adoption Age Area Birth Black race Blood Pressure Caring Client satisfaction Collaborations Communities County Data Data Collection Eligibility Determination Ethnic Origin Focus Groups Goals Health Health Services Accessibility Home Hospitals Improve Access Infrastructure Internet Intervention Interview Leadership Louisiana Manuals Maternal Health Maternal Health Services Maternal health equity Modeling Monitor Not Hispanic or Latino Outcome Patient Outcomes Assessments Patients Persons Phase Postpartum Period Poverty Pregnancy Premature Birth Procedures Process Protocols documentation Provider Race Rural Sampling Services Site Socioeconomic Status Specialist Technology Testing Training Underinsured Underserved Population Weight Woman black women design digital effectiveness/implementation hybrid electronic health record system empowerment experience geographic disparity health care availability high risk implementation barriers implementation evaluation implementation intervention implementation outcomes improved innovation mortality risk obstetric care obstetric services pregnant programs racial disparity remote health care rural area tool

项目摘要

In Louisiana, those living in parishes that lack access to maternal care, referred to as “maternity care deserts” experience a 91% increase in risk of death during pregnancy and up to 1 year postpartum. Black women are already at higher risk independent of their residential status, and counties with larger numbers of non-Hispanic Black women have higher odds of losing all hospital obstetric services. As obstetric care in these largely rural parishes is unlikely, there is a critical need to develop interventions that will improve maternal health care in these areas. The overall objective of this application is to examine the potential of enhanced remote care to improve maternal health. The overall hypothesis is that innovative models of care, based in community priorities and context, can mitigate the lack of high-level services located in these areas. When patients live far from care sites, remote care has obvious advantages, reducing the need for long trips, limiting unnecessary care, and identifying problems earlier. Ochsner’s Connected MOM program (at-home blood pressure and weight monitoring) has been successfully implemented in southern Louisiana and been associated with a reduction in preterm birth. However, Black and rural women were less likely to benefit from the program that white and urban women. The project will be conducted in two phases: In the formative phase (years 1-2), the project goal is to establish community needs, relationships, and infrastructure to conduct a remote care intervention (Connected MOM+) that reflects the community’s leadership and priorities. This will be accomplished by presenting Connected MOM to community groups and determining the service needs, technological challenges, and barriers to implementation of the intervention, via interviews and focus groups. Implementation phase project infrastructure, including protocols, manuals of procedures, data collection tools, provider training, digital infrastructure, and staffing, will then be created. In the implementation phase (years 3- 7), a hybrid effectiveness-implementation stepped-wedge study will be conducted, testing implementation, process, and health outcomes of the enhanced remote care package across 27 parishes in northern Louisiana. Access to care, health, and implementation outcomes (reach/adoption/fidelity) will be examined via the electronic health record system, and patient satisfaction and implementation outcomes (acceptability/appropriateness) assessed in a sample. This project will have an important positive impact by improving the health of, and empowering, a high-risk, underserved population.

在路易斯安那州，居住在缺乏物质护理的教区的人，被称为“产妇护理沙漠” 怀孕期间和产后1年的死亡风险增加了91％。黑人妇女是已经处于较高的风险，独立于其居民身份，并且非西班牙裔数量较大的县黑人妇女失去所有医院产科服务的几率更高。作为这些农村的产科护理教区不太可能，迫切需要开发干预措施，以改善母亲的医疗保健这些区域。该应用程序的总体目的是检查增强远程护理的潜力改善孕产妇的健康。总体假设是基于社区的创新护理模型优先事项和环境可以减轻这些领域缺乏高级服务。当病人居住很远时在护理网站上，远程护理具有明显的优势，减少了对长途旅行的需求，限制了不必要的护理，并早些时候确定问题。 Ochsner的互联妈妈计划（在家血压和体重监测）已在路易斯安那州南部成功实施，并与减少早产。但是，黑人和粗鲁的妇女不太可能从该计划中受益白人和城市妇女。该项目将分为两个阶段：在形成阶段（1-2年），项目目标是建立社区需求，人际关系和基础设施以进行远程护理干预（连接的妈妈+），反映了社区的领导和优先事项。这将是通过向社区群体展示联系并确定服务需求而实现，通过访谈和焦点小组，技术挑战以及实施干预的障碍。实施阶段项目基础架构，包括协议，程序手册，数据收集工具，然后将创建提供商培训，数字基础架构和人员配备。在实施阶段（3年 - 7）将进行一项混合有效性 - 实现阶梯 - 纽奇研究，测试实施，路易斯安那州北部27个教区增强远程护理包的过程以及增强的远程护理套餐的健康成果。将通过访问护理，健康和实施成果（达到/收养/保真度）进行检查电子健康记录系统以及患者满意度和实施结果（可接受性/适当性）在样本中进行了评估。该项目将对改善高风险，服务不足的人口的健康和授权。