Brooklyn Digital Community Care Intervention to Address Unmet Social Needs and Optimize Engagement in Maternal Health Care

布鲁克林数字社区护理干预措施，解决未满足的社会需求并优化孕产妇保健参与

• 批准号: 10606178
• 负责人: Aimee Afable
• 金额: $ 28.09万
• 依托单位: SUNY DOWNSTATE MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10606178
• 关键词: Accountability; Address; Adoption; Americas; Architecture; Behavioral Model; Black race; COVID-19 pandemic; Caring; Client; Clinic; Clinical; Clinical Services; Communities; Community Health; Community Health Aides; Community Practice; Custom; Data; Data Collection; Diffusion of Innovation; Educational Intervention; Ensure; Evaluation; Exhibits; Family; Focus Groups; Food; Foundations; Health; Health Personnel; Health Sciences; Healthcare; Housing; Immigrant; Individual; Information Systems; Institutes; Institutional Racism; Intervention; Interview; Legal Status; Maternal Health; Maternal Health Services; Maternal Mortality; Measurement; Measures; Methods; Modeling; New York City; Outcome; Participant; Pathway interactions; Patient Self-Report; Persons; Pilot Projects; Population; Positioning Attribute; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Protocols documentation; Public Health; Recording of previous events; Records; Research Design; Risk Factors; Screening procedure; Secure; Social Work; Standardization; Surveys; System; Technology; Testing; Time; Training; Universities; Urban Health; Visit; Vulnerable Populations; Woman; Women' s Health; barrier to care; base; black/white disparity; care coordination; community center; community partnership; data sharing; design; digital; digital healthcare; diverse data; evidence base; experience; family support; food security; health care service utilization; health information technology; healthcare community; high risk; implementation framework; improved; informant; marginalized population; meetings; neglect; novel; obstetric outcomes; post intervention; postpartum care; precision medicine; pregnant; primary outcome; process evaluation; programs; prototype; screening; secondary outcome; service uptake; severe maternal morbidity; social; social health determinants; theories; therapy design; treatment as usual

Project Abstract Central Brooklyn is the epicenter of the maternal health crisis in New York City. The highest rates of severe maternal morbidity (SMM), considered “near misses” to maternal death, are found in Black immigrant women, who are concentrated in Central Brooklyn. This situation reflects a history of systemic racism and neglect. Women who lack adequate care throughout pregnancy and post-partum are at higher risk of SMM and death. To address this public health crisis, we will test the preliminary efficacy and acceptability of novel intervention prototype called We Care About Brooklyn (WeCAB), which integrates principles of an evidence-based community-centered care model and employs community health workers (CHWs) to connect with and support families while leveraging a digital social determinants of health (SDOH) screening and closed-loop referral system. We hypothesize that comprehensively addressing SDOH (basic survival needs such as food security, decent housing, and childcare) will reduce barriers to healthcare utilization and improve engagement in care throughout pregnancy and the post-partum period. We propose a mixed-methods study design with the following specific aims: 1) tailor the existing digital SDOH screening tool for Central Brooklyn and build clinician, client and community stakeholder fit to inform the CHW intervention training protocol; 2) conduct a pilot RCT of WeCAB in the Central Brooklyn maternal population to measure acceptability and preliminary efficacy of the system; and 3) identify barriers and facilitators to the adoption and integration of our intervention prototype into routine maternal care through key informant interviews and a post-intervention survey. WeCAB has the long-term potential to improve health during and after pregnancy in America’s historically marginalized maternal populations who experience a disproportionate burden of adverse health outcomes.

项目摘要 布鲁克林中部是纽约市孕产妇健康危机的中心，发病率最高。 严重孕产妇发病率 (SMM) 被认为是孕产妇死亡的“未遂事件”，发现于 黑人移民女性集中在布鲁克林中部，这种情况反映了一种现象。 在整个怀孕期间缺乏足够护理的妇女有系统性种族主义和忽视的历史。 为了解决这一公共卫生危机，我们将面临更高的 SMM 和死亡风险。 测试名为“We Care”的新型干预原型的初步功效和可接受性 关于布鲁克林 (WeCAB)，它整合了以证据为基础、以社区为中心的原则 护理模式并雇用社区卫生工作者 (CHW) 来联系和支持家庭 同时利用数字健康问题社会决定因素 (SDOH) 筛查和闭环转诊 我们采取了全面解决SDOH（基本生存需求，例如 食品安全、体面的住房和儿童保育）将减少医疗保健利用的障碍， 提高整个孕期和产后护理的参与度。 混合方法研究设计具有以下具体目标：1）定制现有的数字 SDOH 布鲁克林中部的筛查工具，并建立适合临床医生、客户和社区利益相关者的工具 告知社区卫生工作者干预培训方案；2) 在中央开展 WeCAB 试点随机对照试验 布鲁克林孕产妇人口，以衡量该系统的可接受性和初步功效；以及 3）确定我们的干预原型的采用和整合的障碍和促进因素 通过关键知情人访谈和 WeCAB 干预后调查了解孕产妇护理常规。 在美国历史上具有改善怀孕期间和怀孕后健康的长期潜力 承受不成比例的不良健康负担的孕产妇群体 结果。