Health Disparity, Minority and Vulnerable Populations, Perinatal Outcomes, Pregnancy, Social Determinants of Health (SDOH)
Conditions
Keywords
pregnancy, social determinants of health, perinatal outcomes
Brief summary
The purpose of this project is to improve perinatal health outcomes in Rhode Island by bringing together the hospital, community health workers (CHWs), doulas, and community-based organizations to build a service delivery model that addresses care coordination and social determinants of health (SDOH) as a part of a concerted effort towards achieving equitable perinatal health outcomes. Over 4 years, the hospital-led project team will implement the community-based maternal support services (COMSS) bundle in 6 affiliated clinics, including care coordination, doula care, and referrals and linkages to community-based organizations that address key SDOH (food, housing, transportation). Maternal and infant health outcomes will be compared pre and post program implementation. The central hypothesis is that COMSS will reduce adverse maternal and infant outcomes and associated racial disparities.
Detailed description
Despite a decreasing global trend, maternal mortality (MM) and severe maternal morbidity (SMM) in the United States continue to increase. Black, Indigenous, and People of Color (BIPOC) have disproportionately higher rates of MM. The causes of SMM/MM and the associated disparities are complex and multidimensional, but there is increasing awareness of the important role of social determinants of health (SDOH) - the conditions in which people are born, grow, live, work, and age - on perinatal outcomes. Addressing perinatal health disparities requires a multipronged approach targeting not only the health system and clinical factors that contribute to inadequate care, but also the social needs of patients from communities experiencing disparities. The purpose of this project is to improve perinatal health outcomes in RI by bringing together the hospital, community health workers (CHWs), doulas, and community-based organizations in participatory model for integrating community-based maternal support services (COMSS). The COMSS program will be implemented in 6 prenatal clinics in Rhode Island. Under a universal screening protocol, all patients at active COMSS sites will be screened by nurses at the first prenatal visit and repeated in the second trimester, third trimester, at delivery and 2-6 weeks postpartum for three sets of risk factors for adverse perinatal outcomes including high risk SDOH (safe housing, food insecurity, lack of reliable transportation). Patients who screen positive will be assigned to a care manager who will work with CHWs to provide care navigation, care linkage, and connection and/or with community-based partner services to address food, housing and transportation needs. Patients will be followed by the care team until at least 3 months postpartum, when they will be transitioned to primary care. Randomization into the COMSS program will occur at the clinic level in a stepped wedge cluster randomized trial. All clusters (i.e prenatal clinics) begin the study in baseline conditions and are randomly assigned to cross-over to the intervention condition at pre-determined time points in a sequential, staggered fashion until all groups receive the intervention. Data from all sites will be collected pre and post intervention.
Interventions
OTHERPerinatal health screening
Patients will be screened by nurses at the first prenatal visit and repeated in the second trimester, third trimester, at delivery and 2-6 weeks postpartum for three sets of risk factors for adverse perinatal outcomes - high risk SDOH, substance use and mental health conditions, and high risk pregnancy factors.
OTHERSupport services
Patients who screen positive for known perinatal risk factors will be assigned to a care manager who will work with community health workers (CHW) to provide care navigation, care linkage, and connection with community-based partner services to address the need identified. Care managers and the CHWs will keep a secure registry of patients and will follow up with them on a weekly or biweekly basis, as appropriate, to ensure continuity of care
Sponsors
Women and Infants Hospital of Rhode Island
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The investigators will use a hybrid implementation-effectiveness stepped wedge cluster randomized trial design for implementation of the Community-based Maternal Support Services (COMSS) model. In a stepped wedge cluster randomized trial, clusters (i.e prenatal clinics) begin the study in baseline conditions and are randomly assigned to cross-over to the intervention condition at pre-determined time points in a sequential, staggered fashion until all groups receive the intervention
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
* All birthing people receiving perinatal care (prenatal, postpartum) at Women and Infants Hospital (WIH) and its affiliated clinics
Exclusion criteria
* Anyone not meeting the above criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of severe maternal morbidity and mortality | from enrollment through 1 year postpartum | any severe maternal morbidity or mortality |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of pregnant people abstinent from alcohol | from enrollment through date of delivery | no alcohol use during pregnancy (based on routine screening measures and information available in medical record) |
| Proportion of pregnant people abstinent from illicit drugs | from enrollment through date of delivery | no use of any illicit drugs during pregnancy (based on routine screening measures and information available in medical record) |
| Infant death | delivery through 1 year of life | — |
| Preterm birth | Delivery | Birth at \<37 weeks GA |
| SDOH screening - Number of prenatal clinics in Rhode Island where COMSS bundle is operational | from enrollment through 6 weeks postpartum | — |
| SDOH screening - # birthing persons screened | from enrollment through 6 weeks postpartum | Number of birthing persons per year who are screened for high-risk social determinants of health, substance use and behavioral health disorders, and high-risk pregnancy factors |
| SDOH screening - # receiving case management | from enrollment through 6 weeks postpartum | Number of individuals per year who receive case management services for addressing high risk SDOH, substance use and behavioral health disorders, and high risk medical and obstetric health diagnoses |
| Rate of cesarean births among low-risk nulliparous patients | delivery | — |
| Proportion of patients who get screened for postpartum depression | from 4-8 weeks postpartum | any depression screening |
| Proportion of patients who receive adequate prenatal care | from enrollment through date of delivery | — |
Countries
United States
Outcome results
None listed