Multilevel community-centered intervention to reduce pregnancy related and associated morbidity and mortality (PRAMM) disparities in Non-Hispanic Black and Hispanic Medicaid-insured individuals

以社区为中心的多层次干预措施，以减少非西班牙裔黑人和西班牙裔医疗补助保险个人中与妊娠相关和相关的发病率和死亡率 (PRAMM) 差异

• 批准号: 10755549
• 负责人: Cristian Ioan Meghea
• 金额: $ 73.8万
• 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/10755549
• 关键词: Active Learning; Address; Advocacy; Advocate; Area; Awareness; Birth; Birth Records; Black race; Caring; Clinical; Communication; Communities; Community Health; Community Health Aides; Community Healthcare; Complement; Complex; County; Data; Death Records; Disparity; Education; Educational Curriculum; Effectiveness of Interventions; Equity; Face; Health Services Accessibility; Health system; Hearing; Hispanic; Home visitation; Hypertension; Individual; Information Systems; Infrastructure; Intervention; Knowledge; Learning; Link; Maternal Health; Maternal Mortality; Medicaid; Mental Health; Methods; Michigan; Modeling; Not Hispanic or Latino; Nurses; Outcome; Participant; Patients; Perinatal; Persons; Policies; Population; Populations at Risk; Postpartum Period; Pregnancy; Provider; Quality of Care; Quasi-experiment; Racial Equity; Recording of previous events; Reporting; Research; Science; Social Conditions; Social Workers; Standardization; Structural Racism; System; Testing; Training; Work; beneficiary; care systems; clinical care; community center; community setting; comorbidity; cost effectiveness; cost-effectiveness evaluation; design; disparities in morbidity; disparity reduction; early pregnancy; effectiveness evaluation; empowerment; evidence base; health disparity; innovation; intervention effect; maternal morbidity; mortality; mortality disparity; multiple chronic conditions; postnatal; pragmatic trial; pregnant; prenatal; programs; provider factors; racism; severe maternal morbidity; skills; testing access; treatment as usual

In this project we will test a multilevel intervention in a large-scale pragmatic trial to reduce Non-Hispanic Black (NHB) and Hispanic pregnancy-related and -associated maternal morbidity and mortality (PRAMM) disparities in three Michigan counties with over ¼ (>2.5M) of the Michigan population. Interventions at each level were co- developed with our partners in these counties, including NHB and Hispanic pregnant persons, community lead- ers, providers, and health system representatives. Community level intervention. We will enhance a commu- nity health worker (CHW)-inclusive home visiting model by increasing pre- and postnatal focus on maternal health and by designing and implementing specific CHW interventions to directly address PRAMM equity in Black and Hispanic Medicaid birthing persons. This approach takes advantage of existing statewide infrastruc- tures in MI and many other states to expand the reach of maternal health disparities interventions. The pro- vider/practice level intervention will address patient-provider interactions through actionable, experiential pro- vider trainings focused on communication (e.g. listening to birthing persons), provider and practice racism, bias, cultural relevance, and awareness of and referrals to community care services including CHWs and home visit- ing, for both clinical and community settings. The study is innovative in that (i) it is the first large-scale test of a scalable and integrated CHW – home visiting program specifically designed for reducing PRAMM and disparities among NHB and Hispanic birthing persons; (ii) will include interventions for specific comorbid conditions relevant to PRAMM and disparities, including multimorbidity; (iii) will be one of the first to address patient-provider inter- actions both from the provider and patient perspective and will incorporate innovative upstream provider training methods such as community health detailing; (iv) and will enhance the coordination of clinical and community care at multiple levels. The study will use a quasi-experimental, stepped wedge design. Participants will be Medicaid insured persons in Wayne, Kent, and Genesee counties observed during pregnancy, at birth, and up to 1 year postpartum, who deliver a birth between 2021-2028 (~101,000 births, including ~39,000 NHB and Hispanic). Analyses will use a statewide linked data system including all Medicaid birth and death records, Med- icaid claims, and other program data. In the context of Michigan extending pregnancy-related Medicaid coverage to 12 months postpartum starting in 2022, the study will be able to evaluate the impact of the proposed multilevel intervention vs usual care from early pregnancy through 12 months postpartum. Specific aims are to: (1) Assess the effectiveness of the intervention (vs usual care) in reducing NHB and Hispanic PRAMM (up to 1-year post- partum; overall & relative to NHW persons) and NHB and Hispanic severe maternal morbidity and pregnancy- associated (which includes pregnancy-related) mortality (overall & relative to NHW persons); (2) Test access to care, quality, and social conditions as mechanisms of the effect of the multilevel intervention on NHB and His- panic PRAMM disparities; (3) Evaluate the cost-effectiveness of the multilevel intervention.

在这个项目中，我们将在大规模务实试验中测试多层次干预措施，以减少非西班牙裔黑色 （NHB）和与西班牙妊娠有关以及与孕产妇发病率（PRAMM）分布 在密歇根州超过1/4（> 2.50万）的三个密歇根州人口中。每个级别的干预措施是共同的 与我们在这些县的合作伙伴一起发展，包括NHB和西班牙裔怀孕者，社区负责人 ERS，提供者和卫生系统代表。社区级别的干预。我们将加强一个交流 Nity卫生工作者（CHW） - 包括家庭访问模型，通过增加产后和产后的关注 健康以及设计和实施特定的CHW干预措施，以直接解决PRAMM权益 黑色和西班牙裔医疗补助生日。这种方法利用现有的全州保险 - MI和许多其他州的风格扩大了母亲健康差异干预措施的影响。专业人士 VIDER/实践水平干预将通过可操作的专家专家来解决患者提供者的互动 vider培训的重点是沟通（例如听生日的人），提供者和练习种族主义，偏见， 文化相关性，以及对包括CHW和家庭访问在内的社区护理服务的认识和推荐 - 对于临床和社区环境。这项研究具有创新性，因为（i）这是对 可扩展和集成的CHW - 专为减少PRAMM和分布而设计的家庭访问计划 在NHB和西班牙裔生日的人中； （ii）将包括有关特定合并条件相关的干预措施 用于PRAMM和分布，包括多个多发病； （iii）将是第一个解决患者培训者之间的问题之一 从提供者和患者的角度采取行动，并将结合上游提供商培训 社区健康细节等方法； （iv）并将增强临床和社区的协调 多个级别的护理。该研究将使用准实验性，阶梯式楔形设计。参与者会 医疗补助在怀孕，出生时和上升期间观察到的韦恩，肯特和杰纳西县的医疗补助人员 至1年的产后，他在2021-2028之间分娩（约101,000个出生，包括〜39,000 NHB和 西班牙裔）。分析将使用全州链接的数据系统，包括所有医疗补助出生和死亡记录，Med- ICAID索赔和其他程序数据。在密歇根州延长与怀孕有关的医疗补助范围的情况下 在2022年开始的产后12个月内，该研究将能够评估所提出的多级的影响 从怀孕初期到产后12个月的干预措施与通常的护理。具体目的是：（1）评估 干预措施（与常规护理）在减少NHB和西班牙裔PRAMM（最多1年后）的有效性 自己总体和相对于NHW人）和NHB和西班牙裔严重的母亲发病率和怀孕 - 相关（包括与怀孕有关的）死亡率（总体和相对于NHW人）； （2）测试访问 护理，质量和社会条件是多层次干预对NHB和HIS-的影响的机制 恐慌的PR差异； （3）评估多级干预的成本效益。