A study between the UNC Chapel-Hill and Orange County Health Department, called “Thriving Hearts: Healing-Centered, Integrated, Community Maternity Care,” has been approved for a $21-million funding award from the Patient-Centered Outcomes Research Institute (PCORI), an independent, nonprofit organization based in Washington, D.C. The funding award will be used to reduce the incidence of hypertensive disorders of pregnancy (HDP) and improve maternal outcomes across 10 North Carolina counties over the next six years.
In the United States, rates of maternal mortality and severe maternal morbidity are rising, especially among Black and American Indian/Alaska Native women and women with disabilities, low incomes, or rural residences. Black women with HDP - a group of high blood pressure disorders that includes preeclampsia and gestational hypertension - are 3.7 times more likely to die from complications and are more likely to experience severe morbidity than their white counterparts.
The project, led by Alison Stuebe, MD, professor of obstetrics and gynecology at the UNC School of Medicine, and Quintana Stewart, director of Orange County’s Health Department, will be coordinating with local health departments, families, and community groups to make pregnancy and birth safer. Their project strategy involves a multi-level intervention to provide support and connection at the individual patient level, the healthcare team level, and the community level.
“The overarching goal of ‘Thriving Hearts’ is to cultivate conditions for mothers to not only survive pregnancy, but to thrive,” said Stuebe, who is also a Distinguished Scholar of Infant and Young Child Feeding at UNC Gillings School of Global Public Health. “By implementing a multi-level intervention, we want to help community advocates, health system leaders, and policymakers understand what types of support matter to growing families.”
A Multi-Level Intervention
The intervention will be delivered by local health departments in Alamance, Caswell, Chatham, Cumberland, Durham, Forsyth, Guilford, Johnston, Orange, and Person Counties, with the goal of strengthening the ecosystem for pregnant and parenting people across each county.
Local health department staff will be supported to work with maternity care practices in their county to implement home blood pressure monitoring, provide healing-centered support for the health care workforce, and meet the emotional, social, and logistical needs of county residents.
In addition to health department staff, the project team is comprised of people with lived experience of HDP, including doulas, community health workers, dieticians, social workers, nurses, and researchers. The team will be providing community-informed, multicomponent interventions that simultaneously address health conditions and social determinants of health at the individual, healthcare provider, and community level.
At the individual level, members of the team will support prenatal clinic staff to determine patients’ risk for developing HDP. Women at high risk will receive a care kit that includes blood pressure-checking tips, a home blood pressure monitor, and a bottle of low-dose aspirin to prevent HDP. They will also be able to sign up for free informational text messages.
Team members will also be deployed to local hospitals and clinics to provide workshops on burnout and compassion fatigue for health department staff and community healthcare providers. Along with providing small grants to neighborhood organizations, the team's community health workers will be contacting pregnant women to introduce them to local resources and events and offering referrals to a Medical Legal Partnership to help solve problems like unsafe housing.
The Five-Year Comparative Effectiveness Study
Researchers will conduct a five-year study to see how well the Thriving Hearts program works. They will track the progress of the participants – about 140,000 women – before and after the Thriving Hearts program begins.
Using hospital records, insurance claims, and birth certificates, the team will track how many women get HDP, and how well the program prevented HDP from developing. About three months after birth, the team will survey the participants about their health, well-being, and care. Healthcare workers will also be surveyed to see if their burnout lessened after their county has the Thriving Hearts program.
Finally, the team will assess how well counties took to Thriving Hearts, and what particular elements were difficult to implement by speaking with patients, community groups, and health team members.
The funding award for the Thriving Hearts study has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
About Orange County Health Department
The mission of Orange County Health Department (OCHD) is to promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. In 2023, North Carolina Local Health Department Accreditation (NCLHDA) Board awarded OCHD Reaccreditation with Honors, highlighted two unique programs during their visit: Family Success Alliance (FSA), which serves families to break the cycle of poverty, and the Gateway Collaborative, which offers services in the Gateway Village housing community with the goal of bringing agencies together to support residents.