Friday, May 17, 2024
5/17/2024
Despite a decreasing global trend, maternal mortality (MM) and severe maternal morbidity (SMM) in the United States (US) continue to increase. Black, Indigenous, and People of Color (BIPOC) have disproportionately higher rates of MM: Black birthing people have a MM ratio that is 2 - 3 times higher than White birthing people. The causes of SMM/MM and the associated disparities are complex and multidimensional including structural racism and inequities in the longitudinal provision of preconception, antenatal, delivery, and postpartum care at the system-, provider-, and patient-levels. 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. SDOH including food security, housing stability, social support, income, education, transportation, neighborhood environment, and employment status have been associated with adverse perinatal health 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 absence of such approaches, as in Rhode Island (RI), contribute to persistent and high rates of SMM/MM and racial disparities. In RI, SMM occurs in 1 in 36 birthing people (2.8%; double the U.S. average of 1.4%) with significant racial disparities: Black patients have a 48% higher rate of SMM compared to White patients, and Latinx patients have a 32% higher rate of SMM compared with non-Latinx patients. Women and Infants Hospital of Rhode Island (WIH) proposes a 5-year project to develop and implement a participatory model for integrating community-based maternal support services (COMSS) into perinatal systems of care. The purpose of this project is to improve perinatal health outcomes in RI by bringing together WIH, community health workers (CHWs) and doulas, and community-based organizations in a deeply participatory process to build a service delivery model that addresses care coordination and SDOH (food, housing, transportation, social support) as a part of a concerted effort towards achieving equitable perinatal health outcomes. Over 80% of deliveries in RI occur at WIH, making the hospital a critical touchpoint for perinatal health. Through this project, all patients who receive prenatal and postpartum services at WIH or one of 6 WIH-affiliated clinics will be screened for 3 risk factors: SDOH, substance use/behavioral health diagnoses, and high-risk pregnancy factors. A positive screen will trigger the involvement of a care manager who will work with a team of CHWs, doulas, physicians, and community-based organizations to create a perinatal health support plan for the patient. By co-designing the COMSS model with community-based organizations, the project team aims to provide culturally and linguistically appropriate care coordination that will reduce perinatal health inequities across the state. In year one of the project, WIH will coordinate a participatory process to finalize the design of the COMSS model and the strategy for implementation into perinatal care. The project team will bring together project partners, doulas, community health workers, obstetric care providers, relevant government agencies, and community-based organizations to develop a plan for increasing access to, and use of, supportive services for perinatal health. In years two to four, the project team will sequentially roll out the COMSS model in 6 WIH-affiliated clinics. In year five we will document continued use of the COMSS bundle after the project activities have ended (maintenance). An independent evaluator will comprehensively evaluate the intervention and develop a plan to disseminate our findings to the broader perinatal health community.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
