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 大多数可预防的孕产妇死亡发生在产时和产后即刻 (PP) 期间， 未发现/治疗不足的心理健康 (MH) 状况（例如自杀、服药过量）引起的并发症以及 在纽约市 (NYC) 的心血管 (CV) 事件中，黑人的孕产妇死亡率是黑人的 8 至 12 倍。 然而，大多数基于社区的计划都致力于解决分娩者的健康问题。 在这一人群中，他们的关注点狭隘于基本服务（例如母乳喂养、社会支持），而获得的服务有限 注重基于证据的护理，解决身体、心理和社会健康需求。 关键的 PP 过渡，从基于创伤和“风险”的方法转向基于力量和赋权的方法 迫切需要许多医院、社区和政府的障碍阻碍广泛采用和扩展。 导乐提供的护理，目前尚不清楚协助者、资产和资源如何改善护理的连续性 以及社区医院联系，为纽约市不同地点的分娩者提供支持。 在患者和卫生系统层面主导的干预措施尚未得到严格评估。 加勒比妇女健康协会和北曼哈顿围产期伙伴关系，我们将解决 通过在三种互补环境中实施和评估妈妈健康生活 (LHMoms) 来弥补差距 和人群（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。 重点关注出院前开始的护理连续性和社区与医疗保健的联系 出院后的前 7 天 (PD) 直至产后六个月，这是恢复健康的关键窗口 预防长期身心健康后遗症，同时解决终身健康的关键决定因素 我们开发了几种创新的、基于证据的干预措施，包括在线教育。 赋权计划（使用我们开发的患者激活学习系统平台）来建立患者自我 在医院内开始倡导；在关键的前 7 天开展由导乐领导的健康紧急检测计划 PD；以及通过创伤知情的导乐提供的认知行为电话干预来解决 PP 抑郁症 我们提出了严格的混合方法。 对 LHMoms 进行研究以解决三个具体目标 在目标 1 中，我们将测试 LHMoms 与注意力的有效性。 在三个医院地点对 450 名随机分娩个体进行的混合 1 型实施试验中进行对照 在布鲁克林、皇后区和曼哈顿北部，这将包括针对每个地区完善和定制干预措施。 网站以最大限度地提高护理质量，建设助产士提供 LHMoms 的能力，并评估以下方面的有效性： 降低 PP 抑郁、改善 CV 健康并创造更好的生活质量 在目标 2 中，我们将分析。 LHMoms 对 PP 医疗保健利用和满意度的影响 在目标 3 中，我们将检查实施情况。 LHMoms 在三个地点干预的过程和结果将推进总体目标。 NY-CHAMP 旨在优化历史上处于不利地位的分娩个体的 PP 结果。