Reducing Racial Disparities in Maternal Care Through Data-Based Accountability and Doula Support
University of North Carolina, Chapel Hill
Summary
This project-also known as "Accountability for Care through Undoing Racism \& Equity for Moms" or ACURE4Moms-aims to reduce Black-White maternal health disparities using multi-level interventions designed to decrease bias in prenatal care, improve care coordination, and increase social support. ACURE4Moms is a pragmatic 4-arm cluster randomized controlled trial conducted with 39 prenatal practices across North Carolina. Practices have been randomly assigned to receive either: Arm 1 (Standard Care): North Carolina Medicaid Care management for high-risk pregnancies; Arm 2 (Data Accountability and Transparency): North Carolina Medicaid Care Management + Practice-level Data Accountability interventions; Arm 3 (Community-Based Doula Support): North Carolina Medicaid Care Management + Community-Based Doula support intervention for high-risk patients during pregnancy and postpartum; or Arm 4 (Data Accountability and Transparency + Community-Based Doula Support): North Carolina Medicaid Care Management + Both Arms 2 and 3 interventions. During each practice's 2-year intervention period, the practice will initiate prenatal care for \~750-1,500 patients (up to 60,000 patients total), whose outcomes the investigators will follow and compare between arms until all these patients have reached 1-year post-delivery.
Description
Pregnancy complications are increasing in the United States, and this is worse for Black patients, who are 3-4 times more likely to die from pregnancy than White patients. Pregnancy complications and deaths cause large physical, social, and financial burdens for patients and their families. Black patients who experience higher levels of institutional racism and discrimination from healthcare providers and institutions are more likely to have pregnancy complications, such as delivering a baby with low birthweight. Low birthweight (less than 5 pounds 9 ounces) is related to many short-term and l…
Eligibility
- Age range
- 12–99 years
- Sex
- Female
- Healthy volunteers
- Yes
Inclusion Criteria: Practices: * Have at least 180 Black patient deliver over 2 years * Be willing to be randomized * Be willing to adhere to the study protocol Patient survey participants: * Start prenatal care at one of the study clinics during study implementation * Self-identify as Black or African American * Able to give consent and complete surveys and interviews in English Practice staff member participants: * Employed as either a provider, nurse/medical assistant, or office administrator at one of the clinics in this study Doula participants: * Provide doula care to patients at…
Interventions
- OtherData Accountability and Transparency
Collaboration with Practice Facilitators; Maternal Early Warning System; Disparities Dashboard; Racial Equity Training
- OtherCommunity-Based Doula (CBD) Support
Community-Based Doula support for high-risk patients; Racial Equity Training
Location
- University of North Carolina at Chapel HillChapel Hill, North Carolina