MARCH
Avera Research Institute at Avera McKennan Hospital
The Maternal American Indian Rural Community Health (MARCH) Center of Excellence at Avera McKennan Hospital aims to provide a platform for researchers, tribal nations, rural communities and key stakeholders to engage in bidirectional communications on maternal health with a focus on American Indian and rural residents.
At a Glance
1
Research Project
20+
Community Partners
Research Topic- Perinatal health care access and quality
Status
Research activities started
Overarching Aims
Leverage long-standing community research partnerships to establish a maternal health research center of excellence with a focus on American Indian and rural populations.
Establish a MARCH community partnership component within the Center of Excellence to provide overall leadership and evaluation, as well as create communication platforms to optimize bidirectional influence and equitable collaborations.
Strengthen and broaden the number of training opportunities in community-based research.
Research Project Details
Perinatal Health Research and Action for Maternal Equity (PHRAME)
This project involves building a community-based system dynamics simulation model that will detail the patient care utilization and quality (PCUQ) barriers and facilitators on person/patient, provider/health system and policy levels driving low PCUQ rates and disparities for American Indian (AI) and low socioeconomic status women. Models will be developed and simulated using a community-based participatory approach with survey data from 380 women (65% AI) who live within the target communities and have had recent pregnancy and/or childbirth experience. The project will develop qualitative community-based system dynamics models detailing the process of mechanisms that drive decision making and implementing actions for changes to perinatal healthcare practice and policy and the role of research during these processes. Models will be developed in collaboration with a sample of health system and policy decision makers and stakeholders, and with a sample of grassroots advocates for AI health and health equity, to further evaluate equity or inequity within decision making and change processes. Key mechanisms for change and equity will be identified through network-based analysis of the qualitative model.
Key Maternal Health Indicators: South Dakota
-
11,201
live births in 2022 1
-
24.0%
of births were cesarean deliveries 1
-
10.4%
of births were preterm 1
-
27.4%
of deliveries were covered by Medicaid 1
-
729
women with life threatening complications per every 100,000 births 2
-
81.6
women die from pregnancy complications or within one year of pregnancy per every 100,000 births 3
-
4.0x
more American Indian women die from pregnancy-associated deaths than White women 3
-
76.9%
of birthing women start prenatal care in the 1st trimester 1
-
23.7%
of women are without a birthing hospital within 30 minutes 4
-
42%
of babies were born to women who live in rural counties 4
Partner Organizations
Community partners include:
- Academic Institutions
- Researchers
- Tribal Nations
- Rural Communities
- Healthcare Organizations
- State Departments
The MARCH Regional Network will include front-line providers, service agencies and community stakeholders in South Dakota. Network meetings will give MARCH investigators direct access to individuals involved in providing health care services for input on progress and dissemination.
MARCH has also established a Transformation Board which includes leaders across healthcare, community agencies, state/federal entities, and private foundations, with the goal of creating a mechanism for more rapid adoption and implementation of MARCH findings to improve health.
“The MARCH Center of Excellence will bring together partners from across the region to seek ways to improve access to care, to better understand the barriers that exist and move forward to bring meaningful change to improve maternal health. We are working together to bring the right level of care, at the right time, to support maternal health, no matter the zip code.”
References
- Data are from 2022 live births occurring within the US to US residents. Cesarean deliveries are the percentage of live births where the final route and method of delivery was cesarean. Preterm births are the percentage of live births where the gestational age at birth was less than 37 weeks. Medicaid coverage is the percentage of live births where the source of payment for the delivery hospitalization was Medicaid. Prenatal care in the 1st trimester is the percentage of live births where the first prenatal appointment occurred between the 1st and 3rd month of pregnancy.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality on CDC WONDER Online Database. - Life threatening complications are deliveries with a diagnosis or procedure code indicating severe maternal morbidity. Information reported for 2020.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases 2010 to 2021. - Number of deaths is based on pregnancy-associated deaths in 2019-2021. The difference in rate of pregnancy-associated deaths between Native Indian and White women is based on deaths in 2012-2021. Pregnancy-associated deaths include deaths during or within one year of pregnancy, regardless of the cause.
Source: South Dakota Department of Health, Pregnancy-Associated and Infant Deaths in SD: 2012-2021. - March of Dimes Maternity Care Deserts Report 2023.