Maternal OutcoMes (MOMs) Program: Testing Integrated Maternal Care Model Approaches to Reduce Risk of Severe Maternal Morbidity

Feinstein Institute For Medical Research, Manhasset NY

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Abstract

There is a maternal health crisis in the United States that disproportionately affects Black women. Black women are two times more likely to experience severe maternal morbidity (SMM) - “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a birthing person’s health” – than non-Hispanic White women. Preventing preeclampsia, increased or maintained engagement in healthy behaviors (e.g., physical activity), and support addressing health-related social needs can enhance receipt of timely, appropriate care and reduce risk for SMM. The Maternal OutcoMes (MOMs) Program implemented at Northwell Health is an effective integrated care approach that identifies and supports high-risk patients immediately post-delivery. In preliminary analysis based on data from 2500 participants, the MOMs Program significantly reduced risk for SMM-related hospital admissions 30-days post-delivery by 77% among Black participants. These preliminary findings are promising; however, the long-term effectiveness needs to be established as well as the feasibility and effectiveness of extending the MOMs Program to the prenatal period. The purpose of this study is to test the effectiveness of an integrated care model approach at two different levels of intensity designed to facilitate timely, appropriate care to reduce risk for SMM. Black and Hispanic pregnant patients with an Obstetrics-Comorbidity Index Score  2 and/or a history of pre-eclampsia will be identified via the electronic health record and 674 will be recruited and randomized early during pregnancy to one of two study arms: MOMs High-Touch (MOMs-HT) vs. MOMs Low-Touch (MOMs-LT). MOMs-HT will consist of close clinical and behavioral health monitoring via chatbot technology and navigation to timely care and services by the MOMs team throughout the prenatal and postpartum periods; 12 bi-weekly self-management support calls with the MOMs team during the prenatal period; and 5 bi-weekly postpartum clinical check-in calls with navigation by the MOMs team up to 6 weeks postpartum. MOMs-LT will also include clinical and behavioral health monitoring via the chatbot along with navigation to services by the MOMs team as needed and 5 bi-weekly postpartum clinical check-in calls with navigation. The two study arms will be compared on incidence of SMM at labor and delivery (Aim 1), incidence rate of SMM-related hospitalizations at 1-month and 1-year postpartum (Aim 1a), time to preeclampsia diagnosis and initiation of treatment (Aim 2), change in perceived social support domains (Aim 3), and physical activity trajectories (exploratory Aim 4). Findings from this study will help to determine how to feasibly implement an effective and sustainable integrated care approach to reduce risk for SMM.