MIRACLE
Michigan State University & Henry Ford Health
The Maternal Health Multilevel Interventions for Racial Equity (MIRACLE) Center of Excellence at Henry Ford Health & Michigan State University Health Sciences works to reduce disparities in pregnancy related and associated illness and death among African American, Hispanic, and rural populations across Michigan.
Michigan State University
Contact
-
Co-Principal Investigator: Dr. Cristian Ioan Meghea
-
Co-Principal Investigator: Dr. Jennifer E Johnson
-
Co-Principal Investigator: Peggy Vander Meulen
-
Center Coordinator: Jennifer Raffo
At a Glance
3
Research Projects
50+
Community Partners
Research Topics- Racial equity
- Pregnancy related and associated morbidity and mortality
- Multilevel interventions
Status
Research activities started
Overarching Aims
To evaluate the effectiveness, cost effectiveness, implementation and population-wide impact of innovative and culturally relevant multilevel interventions to eliminate pregnancy-related and pregnancy-associated maternal morbidity and mortality disparities (PRAMM)
To generate and scale innovative approaches and partnerships for eliminating PRAMM disparities.
Research Project Details
Multilevel community-centered intervention to reduce pregnancy-related and associated morbidity and mortality (PRAMM) disparities in non-Hispanic Black and Hispanic Medicaid-insured individuals
This project is the first large-scale test of a scalable home visiting program integrating community health workers, specifically designed for reducing PRAMMs among Black and Hispanic birthing persons. It will include interventions for PRAMM-relevant comorbid conditions, including multimorbidity, address patient-provider interactions both perspectives, and incorporate innovative provider training methods. The project will evaluate the effectiveness of the intervention in reducing disparities in pregnancy outcomes as well as the cost-effectiveness of the intervention.
High reach, multi level digital intervention for PRAMM disparities
This project builds upon an existing Pregnancy Checkup digital platform, which provides universal digital screening for health risks, brief motivational intervention, and referral to services. This project will extend the platform to address key determinants of PRAMM at multiple levels, optimized to address the needs of Black pregnant people and pregnant people in rural areas. Development will use an innovative community partnered approach to co-create app content. The project will evaluate the program’s effects using a cluster randomized design in 10 geographically and demographically diverse antenatal care clinics throughout Michigan.
Scale-up implementation approached to ending PRAMM disparities
This project will develop a 12-county implementation trial in Michigan focusing on scale-up and sustainment to develop and test approaches to implementing quality improvement maternal safety bundles that: (1) target PRAMM disparities rather than overall quality of care, and (2) target community care (i.e., care provided outside hospitals in outpatient or other community settings) and handoffs between hospital and community care. The project will evaluate the effectiveness and cost-effectiveness of the scale-up implementation intervention using a stepped wedge design with a total population of nearly 6 million people. PRAMM outcomes will be extracted from a pre-existing statewide linked dataset.
Key Maternal Health Indicators: Michigan
-
102,321
live births in 2022 1
-
33.1%
of births were cesarean deliveries 1
-
10.4%
of births were preterm 1
-
37.8%
of deliveries were covered by Medicaid 1
-
889
women with life-threatening complications per every 100,000 births 2
-
23.2
women die from pregnancy complications per every 100,000 births 3
-
2.8x
more Black women die from pregnancy complications than White women 3
-
Top-3 causes
of pregnancy-related deaths: cardiovascular conditions, hypertensive disorders of pregnancy, and hemorrhage 3
-
4.6%
of women are without a birthing hospital within 30 minutes 4
-
77.8%
of birthing women start prenatal care in the 1st trimester 1
-
45.4
women die from pregnancy-associated, not related causes, per every 100,000 births 5
-
Top-3 causes
of pregnancy-associated, not related deaths: substance use disorder, medical, and homicide 5
Partner Organizations
- Corewell Health
- Henry Ford Health
- Detroit Maternal, Child and Family Health Alliance, comprised of 30+ organizations
- Strong Beginnings, a partnership of 7 community agencies
- Flint Community Based Organization Partners (CBOP)
- Flint Odyssey House Health Awareness Center
- Flint Innovation Solutions
- Michigan Department of Health and Human Services
- Women-Inspired Neighborhood (WIN) Network
- Hurley Medical Center
- Munson Healthcare
- MyMichigan Health
- Wayne State University
- Michigan Community Health Worker Alliance
- McLaren Medical Group
- Revive Community Health Center
A Community Advisory Board has also been developed with a broad stakeholder group to act as full partners in increasing the relevance and reach of Center activities.
“The MIRACLE Center will test multiple community-informed interventions to eliminate the disparities in illness and death that occur during pregnancy and postpartum, particularly among Black, Hispanic and rural residents. The center is built on partnerships among university researchers, doctors, nurses, other clinical practitioners, community health workers, and brings community and birthing persons’ perspectives and voices into all phases of the research."
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-related deaths in 2019. The difference in rate of pregnancy-related deaths between Black and White women and top 3 causes of pregnancy-related deaths are based on deaths in 2015-2019. Pregnancy-related deaths include deaths during or within a year of pregnancy from causes related to or aggravated by the pregnancy or its management.
Source: Michigan Department of Health & Human Services, Michigan Maternal Mortality Surveillance Program. Maternal Deaths in Michigan, 2015-2019. - March of Dimes Maternity Care Deserts Report 2023.
- Number of deaths is based on pregnancy-associated, not related deaths in 2019. Top 3 causes of pregnancy-associated, not related deaths are based on deaths in 2015-2019. Pregnancy-associated, not related deaths include deaths during or within one year of pregnancy unrelated to the pregnancy.
Source: Michigan Department of Health & Human Services, Michigan Maternal Mortality Surveillance Program. Maternal Deaths in Michigan, 2015-2019.