The association of a person-centered care intervention during childbirth with clinical and patient-reported outcomes in Washington state hospitals - PROJECT SUMMARY/ ABSTRACT Significance: Compared to peer countries, birthing people in the US are more likely to experience unnecessary interventions during childbirth, making childbirth more expensive while putting birthing people at an increased risk of adverse pregnancy complications and mortality. A growing body of work estimates that between 16-20% of women in the US experienced a form of mistreatment during pregnancy care, and mistreatment may be associated with unnecessary clinical interventions during childbirth, birth trauma, and mortality. A person-centered approach may be an antidote to disrespectful care, over-intervention, and poor health outcomes during the perinatal period. TeamBirth is a person-centered care intervention during childbirth that puts the birthing person at the center of a team-based decision-making process. TeamBirth is currently being implemented across 55 hospitals in Washington state. While pilot studies have shown that TeamBirth is feasible and acceptable to implement among clinicians, no studies have tested the association of TeamBirth on clinical outcomes or patient perceptions of care. Specific Aims: This study leverages an ongoing intervention across 55 hospitals in Washington state to estimate the impact of TeamBirth on (1) birthing persons’ perceived autonomy in decision-making during childbirth and (2) Cesarean delivery among low-risk birthing people before and after implementation of TeamBirth. Approach: The proposed analysis will utilize data from two data sources: (1) patient surveys administered during in-patient postpartum care and (2) chart abstracted data from the Obstetrical Care Outcomes Assessment Program (OB COAP) and the Washington State Hospital Association Maternal Data Center (WSHA-MDC). Using a pre-post design and multiple linear regression, aim 1 will assess the change in birthing persons’ perceived autonomy in decision-making before and after implementation of TeamBirth. Aim 2 will use a retrospective birth cohort and log-risk regression to estimate the risk ratio and 95% confidence interval of Cesarean section given exposure to TeamBirth among low-risk birthing people. Fellowship Information: The applicant is a PhD student in Maternal and Child Health and has completed a minor in Epidemiology at The University of North Carolina in Chapel Hill. Ms. Spigel’s application is supported by a multidisciplinary team of mentors with expertise in perinatal nursing, person-centered care, perinatal epidemiology, applied microeconomics, evaluation of maternal health interventions, and implementation of TeamBirth. Through coursework in maternal health, epidemiology, quasi-experimental methods, coupled with support from an exemplary team of mentors, the proposed training plan will assist Ms. Spigel in successfully completing her dissertation work, and achieving her long-term goal of becoming a successful independent researcher with expertise in the quality and experience of care during the perinatal period.
