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. 2022 Sep:120:106894.
doi: 10.1016/j.cct.2022.106894. Epub 2022 Aug 24.

Study protocol: The Maternal Health Multilevel Intervention for Racial Equity (Maternal Health MIRACLE) Project

Jennifer E Johnson  1 , LeeAnne Roman  2 , Kent D Key  3 , Margaret Vander Meulen  4 , Jennifer E Raffo  5 , Zhehui Luo  6 , Claire E Margerison  7 , Adesuwa Olomu  8 , Vicki Johnson-Lawrence  9 , Jonne McCoy White  10 , Cristian Meghea  11
Affiliations

Study protocol: The Maternal Health Multilevel Intervention for Racial Equity (Maternal Health MIRACLE) Project

Jennifer E Johnson et al. Contemp Clin Trials. 2022 Sep.

Abstract

Purpose: To test the effectiveness and cost-effectiveness of a multilevel intervention for population-level African American (AA) severe maternal morbidity and mortality.

Background: Severe maternal morbidity and mortality in the U.S. disproportionately affect AA women. Inequities occur at many levels, including community, provider, and health system levels.

Design: Intervention. Throughout the two intervention counties, we will expand access to enhanced prenatal care services using telehealth and flexible scheduling (community level), provide actionable maternal health-focused anti-racism training (provider level), and implement equity-focused community care maternal safety bundles (health system level). Partnership. Interventions were developed/co-developed by intervention county partners, including AA women, enhanced prenatal care staff, and health providers. For equity, 46% of project direct cost dollars go to our partners. Most study investigators are female (75%) and/or AA (38%). Partners are overwhelmingly AA women. Sample, measures, analyses. We use a quasi-experimental difference-in-differences with propensity scores approach to compare pre (2016-2019) to post (2022-2025) changes in outcomes for Medicaid-insured women in intervention counties to similar women in the other Michigan, USA, counties. The sample includes all Medicaid-insured deliveries in Michigan during these years (n ~ 540,000), with women observed during pregnancy, at birth, and up to 1 year postpartum. Measures are taken from a linked dataset that includes Medicaid claims and vital records.

Conclusion: This study is among the first to examine effects of any multilevel intervention on AA severe maternal morbidity and mortality. It features a rigorous quasi-experimental design, multilevel multi-partner county-wide interventions developed by community partners, and assessment of intervention effects using population-level data.

Trial registration: ClinicalTrials.gov NCT05386316.

Keywords: African American; Health disparity; Healthcare disparities; Maternal health; Maternal health services; Maternal mortality.

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Conflict of interest statement

Declaration of Competing Interest The authors have no competing interests. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1. Conceptual model merging Howell multilevel inequities and the Right to Health Framework,
For explanation of abbreviations, see Table 1.
See this image and copyright information in PMC

References

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