Improving Postpartum Maternal Outcomes for Populations Experiencing Disparities -– Cycle 2 2022

This Targeted PCORI Funding Announcement (Targeted PFA) seeks to fund large randomized controlled trials (RCTs) and/or well-designed observational studies comparing multicomponent strategies to improve early detection of, and timely care for, complications up to six weeks postpartum for groups more often underserved or experiencing the greatest disparities in health outcomes, including Black, American Indian/Alaska Native (AI/AN), Hispanic, rural, and low socioeconomic status (SES) populations.

The United States ranks lowest among high income countries in parameters for maternal health, and 40 percent of US maternal mortality occurs during the first six weeks following delivery. Significant disparities for maternal outcomes have been reported for Black, AI/AN, Hispanic, rural, and low SES women. Although evidence-based treatments and care protocols exist for the prevention of postpartum severe maternal morbidity and mortality, postpartum care is typically limited, and there is evidence that important warning signs may be missed or dismissed by patients, as well as clinicians and systems. Signs or symptoms may overlap with those of other conditions and with those of recovery from delivery. Patients and primary or emergency care clinicians also may be unaware of the importance of recent pregnancy status for the interpretation of some symptoms and may not discuss it, and patients experiencing complications in the hospital may not receive referrals to appropriate specialty care. In addition, systemic racism and bias (conscious and unconscious) affect access to and quality of care, and significant inequities persist in access to and availability of timely, appropriate, and respectful postpartum care.

Various strategies to improve postpartum care and outcomes and eliminate disparities and advance health equity have been recommended and/or implemented by professional organizations, health systems and clinicians. Such strategies may be designed to increase awareness and detection of postpartum complications by patients and clinicians, and/or to improve structural competence and overcome bias and inequities in postpartum care.  

This Targeted PFA will solicit applications that respond to the following question:

What is the comparative effectiveness of multicomponent interventions to improve early detection of, and timely care for, risk factors for postpartum complications and for complications during the first six weeks postpartum for Black, AI/AN, Hispanic, rural, and low SES patients?  

The reissued funding announcement will emphasize the following:

• Applicants will be asked to propose studies with primary health and/or health utilization postpartum outcomes that are clinically meaningful and considered important by patients. Composite primary outcomes should be well-justified, and their components should be clearly described. Secondary outcomes of interest may include patient experience, satisfaction, and engagement with care.
• Interventions must be evidence-based and/or in widespread use and reproducible.
• Large randomized controlled trials (RCTs) are preferred; robust observational studies will also be considered if an RCT is not possible, and the proposed approach appropriately controls for confounding.
• Studies should be powered to allow for conclusions regarding the populations of interest.