Background: Indigenous mothers are dying at rates 2-3 times higher than non-Hispanic white mothers in the United States, yet research examining regional nuances and addressing root causes in these populations is scarce. Patient-centered outcomes research (PCOR) approaches will produce an actionable research agenda that can guide collection of meaningful data in the Southern Plains, identify drivers of maternal mortality and morbidity, elucidate root causes, and ultimately advance the safety and vitality of Indigenous mothers in the region. The Southern Plains (i.e., Oklahoma, Kansas, and Texas) are home to 44 federally recognized tribes and represent the largest Indian Health Service (IHS) user population area. It is also important to note that most Indigenous births occur in tribal or IHS hospitals.   

Proposed Solution to the Problem: Developing a culturally safe, regionally and situationally specific PCOR/comparative clinical effectiveness research (CER) agenda is a solution for conducting in-depth community- and health systems-oriented needs assessments and influencing future research that is designed to identify and elucidate drivers and root causes of Indigenous maternal morbidity and mortality. Such research may bring into focus the systems, structures, laws, policies, norms, and practices that determine the distribution of maternal health-related resources, which in turn shape Indigenous patients/mothers’ health outcomes. This solution requires collaboration of diverse Indigenous women, tribal communities, and stakeholders.

Objectives: To develop and initiate a PCOR/CER agenda to advance the safety and vitality of Indigenous mothers in the Southern Plains and set the stage for broad collaboration to advance maternal health equity. We aim to develop a consortium of stakeholders through a single point of contact model and to build a sustainable framework and plan to implement the PCOR/CER agenda.

Activities: Phase 1: Recruit a representative Southern Plains Stakeholder Engagement Leadership Council (SELC) to guide the project and host two-day virtual stakeholder retreat to cocreate an outline for the PCOR/CER agenda; Phase 2: Convene thematic working groups and create an online hub for the consortium’s ongoing work; Phase 3: Compile and refine working group strategies and recommendations to culminate in a single, actionable PCOR/CER agenda. Working groups will meet six times to set strategic priorities for the PCOR/CER agenda. The project will end with a half-day virtual retreat to finalize the agenda, debrief, and plan next steps.

Projected Outcomes and Outputs:
The projected short-term outcome during the project period is the creation of a regional consortium comprised of Indigenous women, providers, and tribal, academic, health system, and IHS/policy partners who are invested in advancing Indigenous maternal safety and vitality to address root causes of maternal mortality and morbidity. The primary deliverable is a PCOR/CER agenda that will advance our objectives by providing a well-informed, strategic, and unified approach, or roadmap, to guide future patient-centered and comparative effectiveness research in ways that are culturally and situationally relevant in the region.

Medium-term outcome (0-2 years post-project period): Tribal communities, health systems, and stakeholder groups will be supported to deploy and enact the agenda through vital partnerships established during the project.

Long-term goal (3+ years post-project period): To develop and initiate PCOR/CER studies, standards of care, policies and procedures, and implement programs to promote culturally safe care that optimizes Indigenous maternal health.

Patient and Stakeholder Engagement Plan: Connected via the extensive Southern Plains Tribal Health Board network, a consortium of Indigenous mothers/patients, tribal leaders, providers, academic/researchers, health system, and IHS/policy partners will engage virtually/synchronously over three ‘retreat’ days, and working groups will meet virtually for one to two hours every other month, between retreats.

Project Collaborators: The Southern Plains Tribal Health Board, Oklahoma City Area Indian Health Service, Chickasaw Nation Department of Health, Oklahoma City Indian Clinic, and Oklahoma University (OU) Health Maternal Fetal Medicine Section are primary collaborators.