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Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality

Award Number: R01MD016003
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/14/2020
PERIOD OF PERFORMANCE END DATE: 04/30/2026

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Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality - Severe maternal morbidity and mortality in the U.S. disproportionately affect African-American (AA) women. Inequities occur at many levels, including community, provider/practice, and health system levels. This proposal will test the effectiveness and cost-effectiveness of a multilevel intervention to address AA maternal morbidity and mortality in two Michigan counties: Genesee County (which includes Flint) and Kent County (which includes Grand Rapids). Interventions were developed or co-developed by our partners in these counties, who include AA women residents, enhanced prenatal and postnatal care (EPC) staff (including race-matched community health workers), and physician/health system staff and providers. Community level intervention. We will expand access to EPC services (i.e., home visiting programs, Healthy Start programs) using telehealth and flexible scheduling. Despite being designed for minority women, about 60% of eligible AA women in Michigan do not enroll in EPC services. Pilot work indicates that 50% of minority women who declined EPC services would participate if a telehealth option was available. We will provide this option. Provider/practice level intervention. We will address provider and health system implicit and explicit bias and corresponding structures and practices and make this learning actionable using daylong experiential trainings. Training will include didactics, reflection, discussion, windshield tours, and brainstorming ways to tailor participants’ practices and settings to better meet the needs of perinatal AA women. Training will include everyone from physicians to front desk staff. System level intervention. We will implement community care patient safety bundles targeting maternal health disparities throughout the intervention counties. We will test the effects of the multilevel intervention using a quasi-experimental difference-in-difference with propensity scores approach to compare pre (2016-2019) to post (2021-2024) changes in outcomes among Medicaid women in the two intervention counties with similar women in other Michigan counties. The sample will include all Medicaid insured women observed during pregnancy, at birth, and/or up to 1 year postpartum, who delivered in Michigan from 2016 – 2024 (approximately 540,000 births, including ~162,000 births to AA women). Measures will be taken from a pre-existing linked dataset that includes Medicaid claims, death records, birth records, and EPC program data. The specific aims are to: (1) Assess the effectiveness of the multilevel intervention on AA severe maternal morbidity and mortality; (2) Test improved service utilization and non-severe maternal morbidity as mechanisms of the effect of the multilevel intervention on severe maternal morbidity, and (3) Evaluate the cost-effectiveness of the multilevel intervention. This project will be among the first to evaluate a multilevel intervention to reduce AA maternal morbidity and mortality at the population level. The trial tests whether the intervention engages the mechanisms presumed to underlie intervention effects and provides cost-effectiveness data that systems need to make informed decisions about adoption, speeding implementation.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $746,296 )
2024	2024	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	000	5	5/12/2024	NON-COMPETING CONTINUATION	$746,296
														Subtotal = $746,296

Issue Date FY: 2023 ( Subtotal = $776,228 )
2023	2023	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	000	4	4/22/2023	NON-COMPETING CONTINUATION	$776,228
														Subtotal = $776,228

Issue Date FY: 2022 ( Subtotal = $780,884 )
2022	2022	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	000	3	4/16/2022	NON-COMPETING CONTINUATION	$780,884
2022	2021	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	001	2	6/6/2022	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $780,884

Issue Date FY: 2021 ( Subtotal = $1,001,539 )
2021	2021	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	002	2	8/25/2021	SUPPLEMENT FOR EXPANSION	$219,090
2021	2021	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	001	2	4/27/2021	NON-COMPETING CONTINUATION	$782,449
2021	2020	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	000	1	4/26/2021	NEW	$0
														Subtotal = $1,001,539

Issue Date FY: 2020 ( Subtotal = $800,966 )
2020	2020	MICHIGAN STATE UNIVERSITY	426 AUDITORIUM RD RM 2	EAST LANSING	MI	48824	INGHAM	USA	Minority Health and Health Disparities Research	000	1	9/14/2020	NEW	$800,966
														Subtotal = $800,966

Grand Total All Awards = $4,105,913

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Meeting women where they are: Multilevel intervention addressing racial disparities in maternal morbidity and mortality

Award Number: R01MD016003

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/14/2020

PERIOD OF PERFORMANCE END DATE: 04/30/2026

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