High reach, multi-level digital intervention for Pregnancy-Related and -Associated Morbidity and Mortality (PRAMM) Disparities

针对妊娠相关和相关发病率和死亡率 (PRAMM) 差异的高覆盖范围、多层次数字干预

• 批准号: 10755550
• 负责人: Claire E Margerison
• 金额: $ 74.91万
• 依托单位: HENRY FORD HEALTH + MICHIGAN STATE 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/10755550
• 关键词: Abnormal coordination; Address; Adopted; Awareness; Behavioral; Birth; Birth Records; Black Populations; Black race; Cessation of life; Clinic; Collaborations; Color; Communities; Community Health Aides; Country; Data; Data Set; Development; Disparity; Early identification; Elements; Enrollment; Ensure; Family member; Feedback; Geography; Health; Health Personnel; Health Services Accessibility; Home visitation; Income; Individual; Intervention; Knowledge; Life Style; Link; Manuals; Maternal Health; Maternal Mortality; Measures; Mediation; Medicaid; Mental Depression; Mental Health; Michigan; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Participant; Patients; Persons; Postpartum Period; Pregnancy; Pregnancy Rate; Primary Care; Privatization; Provider; Racial Equity; Recommendation; Research; Research Personnel; Resources; Risk; Risk Factors; Rural; Sampling; Secure; Services; Site; Social support; Structure; Support System; Symptoms; Technology; Text; Translating; antenatal; antenatal care; brief motivational intervention; checkup examination; cluster randomized design; community-level factor; cost effective; cost effectiveness; design; digital; digital intervention; disparities in morbidity; efficacy testing; flexibility; health care settings; implicit bias; improved; indexing; ineffective therapies; innovation; maternal morbidity; mortality; mortality disparity; mortality risk; novel; open source; partner violence; people of color; pregnant; primary outcome; programs; provider communication; provider factors; randomized trial; residence; rural area; scale up; screening; secondary outcome; service providers; social; social stigma; substance use; underserved rural area; urban area; urban residence

Rates of pregnancy-associated and related morbidity and mortality (PRAMM) are far higher in the U.S. than in any other high-income country, particularly in rural areas and among non-Hispanic (NH) Black birthing people. Technology has clear potential for reduction of PRAMM by providing screening, tailored digital content, and connection to live assistance. Digital approaches also provide tremendous scalability and potential for long-term optimization. Finally, technology that is sufficiently flexible and easy to use—as is the platform used in this project—can also support deep community input through direct content creation. The proposed study builds upon an existing app (the Pregnancy Checkup) developed by project PI Ondersma, already integrated with antenatal services throughout Michigan, that provides universal digital screening for health risks, a brief motivational intervention, and referral to services. The proposed project will create the Pregnancy Checkup- PRAMM (PC-PRAMM) by extending the Pregnancy Checkup in two ways: (1) adding elements to address key determinants of PRAMM risks at four distinct levels (individual, support system, provider, and community), with further optimization to address the needs of Black pregnant people and those residing in underserved rural areas; and (2) providing pregnant participants with immediate and secure “live chat” text access to a Community Health Worker who can facilitate warm handoffs to local services. Development of PC-PRAMM will use an innovative community partnered approach to co-creating app content. The PC-PRAMM will target known preventable determinants of PRAMM at four levels throughout pregnancy and the first year postpartum. Our first specific aim is to collaborate with pregnant and postpartum people (including people of color and those from rural areas), healthcare providers, family members, and researchers to develop the PC-PRAMM, including a manual for CHWs providing live chat assistance and facilitating engagement in services. Our second specific aim is to evaluate PC-PRAMM effects using a cluster randomized design in 10 geographically and demographically diverse antenatal care clinics throughout Michigan (N = 500 participants receiving Medicaid and enrolled at less than 20 weeks gestation). We will measure change on an index of PRAMM risk factors directly targeted by the PC-PRAMM (e.g., substance use, treatment-seeking, partner violence, early warning sign awareness, mental health); total PRAMM among trial participants through 1 year postpartum as measured using a pre-existing linked dataset of Medicaid claims, deaths, birth records, and primary care program data, and disparities in both measures. This innovative community-engaged trial will translate key findings from PRAMM research into a technology-driven intervention with strong potential for cost-effective dissemination. If supported, this approach could provide a highly scalable approach to PRAMM reduction, particularly among Black people and in rural areas. Further, the novel open-source platform on which the PC-PRAMM is built would allow long-term optimization and adaptation based on new findings, quality improvement, and regional needs.

在美国，与怀孕相关的率和相关的发病率和死亡率（PRAMM）在美国高于 任何其他高收入国家，尤其是在粗糙的地区和非西班牙裔（NH）黑人生日的人。 技术通过提供筛选，量身定制的数字内容，具有清晰的PRAMM潜力 并与实时帮助的联系。数字方法还提供了巨大的可扩展性和潜力 长期优化。最后，足够灵活且易于使用的技术 - 正如使用的平台 该项目 - 还可以通过直接的内容创建来支持深厚的社区意见。拟议的研究建造 在现有的应用程序（妊娠检查）由Pi Ondersma项目开发的情况下，已经集成了 整个密歇根州的产前服务，为健康风险提供通用的数字筛查，简要介绍 动机干预和转介服务。拟议的项目将创建怀孕检查 - PRAMM（PC-PRAMM）通过以两种方式扩展怀孕检查：（1）添加元素以寻求密钥 确定四个不同级别的PRAMM风险（个人，支持系统，提供商和社区），并确定 进一步的优化，以满足黑人孕妇和居住在服务不足的农村地区的需求； （2）为怀孕的参与者提供立即安全的“实时聊天”文本访问社区健康 可以促进当地服务的热情洋溢的工人。 PC-PRAMM的开发将使用创新 社区合作的方法共同创建应用程序内容。 PC-PRAMM将针对已知可预防的目标 PRAMM在整个怀孕期间和产后第一年的四个级别的决定因素。我们的第一个特定 目的是与怀孕和产后人合作（包括有色人种以及 粗糙区域），医疗保健提供者，家庭成员和研究人员开发PC-PRAMM，包括 CHW的手册，提供实时聊天帮助并支持服务的参与。我们的第二个特定 目的是使用10个地理上的群集随机设计评估PC-PRAMM效应 整个密歇根州的人口统计学多样化的产前护理诊所（n = 500名接受医疗补助的参与者 并在不到20周的妊娠中注册）。我们将衡量PRAMM风险因素指数的变化 由PC-PRAMM直接针对（例如，药物使用，寻求治疗，伴侣暴力，预警 签署意识，心理健康）；通过测量 使用医疗补助索赔，死亡，出生记录和初级保健计划数据的链接链接数据集， 和两种措施的差异。这项创新的社区参与试验将转化 对技术驱动的干预措施的PRAMM研究具有强大的具有成本效益的传播潜力。如果 得到的，这种方法可以为PRAMM减少提供高度可扩展的方法，尤其是在 黑人和粗糙的地区。此外，建立PC-PRAMM的新型开源平台将 根据新发现，质量改善和区域需求，允许长期优化和适应。