Building on our strengths: redesigning perinatal care to reduce maternal morbidity and mortality among Native Hawaiians throughout Hawaii

According to the Center for Disease Control and Prevention's Pregnancy Mortality Surveillance System in 2017-2019 Native Hawaiians or Pacific Islander (NHPI) persons had the highest pregnancy-related mortality ratio. At 62.8 deaths per 100 000 live births the NHPI PRMR was 60% higher than that of non-Hispanic Black persons (39.9 deaths per 100 000 live births) and almost 450% higher than that of non-Hispanic white persons (14.1 per 100 000 live births). Most data about maternal morbidity and mortality in the state is not accurately disaggregated in a manner to provide insight about this specific population and perinatal service providers across the state have not been engaged in meaningful discussions about addressing these disparities.

Goals and objectives:

Goal 1) We will develop a comprehensive and sustainable model for synthesizing and analyzing disparate statewide datasets to better identify and respond to predictors of maternal mortality and severe maternal morbidity in Hawaii and incorporate these into the design of the perinatal medical home model. We will use principles of data justice outlined by Native Hawaiian leaders. 1. Complete analyses of unanalyzed statewide data to describe severe maternal morbidity and mortality focusing on effectively disaggregating data using the principles of data justice 2. Propose develop and implement a new data extraction and collation model as the foundation for an ongoing statewide data repository 3. Provide research mentorship and professional development for early-stage investigators from diverse backgrounds interested in large data set analysis Goal 2) Conduct in-depth qualitative analysis with the community's perinatal stakeholders to understand the experience of perinatal care provision in the community and identify strengths to be further leveraged in the development of a perinatal medical home model. 1. Conduct a statewide listening tour with community members and perinatal service providers to identify strengths and needs of the community regarding perinatal health 2. Conduct key informant interviews documenting current status strengths and gaps in the statewide perinatal service provision 3. Create a statewide resource map documenting for perinatal and family service providers throughout the state 4. Provide research mentorship and professional development for early-stage investigators from diverse backgrounds interested in qualitative analysis Goal 3) Design and launch a pilot perinatal medical home model in two high-priority communities to be tested and evaluated for its potential to become a model for statewide expansion 1. Define the key pillars and essential features of a perinatal medical home model 2. Develop an implementation plan including site selection study design and evaluation and analysis metrics 3. Launch the perinatal medical home model 4. Analyze and modify perinatal medical home model for scaling and additional funding 5. Provide research mentorship and professional development for early-stage investigators from diverse backgrounds interested in clinical research and implementation science METHODS: We will use a mixed-methods approach with a strengths-focused lens to achieve the goals of this project. This includes quantitative data analysis qualitative analysis of key informant interviews with perinatal care providers and stakeholders and piloting of a perinatal medical home model in two communities.

Products:

Manuscripts in peer-reviewed journals presentations at professional meetings and reports and presentations to the community plus a statewide resource map.

Evaluation:

Each stage of our project includes an evaluation review and response period to make real-time adjustments to project implementation and ensure we are on-track for each objective.