Rachel Mayer on the Fight Against Maternal Mortality

Cameron Boozarjomehri（左）Rachel Mayer（右）。照片：亚当·巴恩斯

Interviewer: Cameron Boozarjomehri

欢迎使用知识驱动的播客的最新部分。在本系列中，软件系统工程师Cameron Boozarjomehri采访了Miter的技术领导者，他们使知识共享和协作成为其实践中不可或缺的一部分。

Rachel Mayer has grown up with medicine on the mind, but one subject has always been at the forefront: Maternal mortality. In a country as advanced and capable as the United States, why is Maternal Mortality still so high? While many public health practitioners often turn to medicinal interventions, she turned to data. Listen in as Rachel guides us through how她自己在MITER Innovation计划中的工作正在帮助拯救到处的母亲和儿童.

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Podcast Transcript
Cameron:	00:15	您好，欢迎来到Miter的知识驱动播客，这是我的主持人Cameron Boozarjomehri的节目，在Miter中采访了聪明的头脑。今天，我与不断有才华的瑞秋·梅耶（Rachel Mayer）一起，他将向我们介绍一个相当病态但非常重要的主题，目前困扰着美国，以及米特（Miter）如何努力帮助克服这个问题。雷切尔，您想自我介绍吗？
Rachel:	00:37	谢谢，卡梅隆。正如您所说，我叫Rachel Mayer。我是MITER的高级卫生系统分析师，并且是我们的孕产妇死亡率研究项目的首席研究员。为什么我来到MITER以及为什么我对这个话题非常着迷的原因是，我一直非常努力地朝着公共卫生的发展，并解决了整个美国医疗保健系统面临的一些问题。我在临床医生的包围下长大，我总是很感兴趣地问那些棘手的问题并找到解决方案。
Rachel:	01:13	I feel very fortunate that MITRE is investing the time and resources to tackle this important issue and that I get to dedicate my work time through the MITRE Innovation Program to research and try to help solve this tough challenge.
Cameron:	01:30	Thank you so much for joining us. Yeah, this is actually something that I’ve been hearing a lot about actually in different parts of MITRE. I’m sure anyone who’s listened to previous episodes will know the MITRE Innovation Program is just an ongoing project where anyone who has a good idea that we really think will help the world can come and pitch the idea and get it funded. I’m glad to see, especially for this problem, that you were able to get funded. So with that in mind, why don’t you give us a little more background on exactly what maternal mortality is and what this bigger problem you’re trying to address is?
Rachel:	02:02	当然。根据疾病预防控制中心的定义，死亡可以归类为妇女怀孕或产后一年的妇女时与妊娠有关的死亡。世界卫生组织有一个不同的定义，将与妊娠有关的死亡定义为孕妇或产后42天的妇女死亡。因此，重要的是要注意这些差异，我们正在使用CDC的定义以及美国境内的大多数实体。
Rachel:	02:33	美国是世界上唯一的发达国家，其孕产妇死亡率提高，并且在这些速度之内存在显着的种族差异。非西班牙裔黑人妇女的患者与白人妇女相关的死亡的可能性高三到四倍。尽管干预措施减少了几十年，但这些种族差异一直持续了几十年。我们最初开始的是真正试图了解美国当前的孕产妇护理计划状态，为什么美国的孕产妇死亡率正在增加，而如何减少它？
Rachel:	03:14	加利福尼亚在这个领域取得了最大的成功。他们代表了一个孕产科死亡率审查委员会，一组跨学科专家团队聚集在一起，确定这些与妊娠有关的死亡以及实际上可以预防的因果关系。在全国范围内，这些孕产妇死亡中约有60％实际上是可以预防的，这意味着可以采取一些干预来挽救该妇女的生命。这些委员会决定了因果关系和预防性，然后加利福尼亚专门设计了这些工具包，以解决与妊娠相关死亡的主要原因。他们在加利福尼亚州实施了这些工具包，在实施这些工具包的七年内，他们将其孕产妇死亡率降低了55％，当您考虑到该国其他任何地方的事实都在增加，这真是令人惊讶。
Cameron:	04:10	With that in mind, I’d actually like to unpack a lot of what you just said. I think the first thing I’d really want to understand is …the American medical system is full of so many different actors and factors, I imagine it was really difficult for them or anyone to really find the data that would even hint at what any solution might be. Do you think you could speak a little to how they came up with the data and how they were able to work through that process?
Rachel:	04:34	重要的是要注意与妊娠相关的死亡和与妊娠有关的死亡之间的差异。如果一个女人发生车祸，并且……怀孕并死亡，但死亡是因为她发生了车祸，但不一定是因为她怀孕了，无论情况如何她去世时怀孕了，她将被拉入一群女性样本中，然后被审查以查看她的死亡。但是，与怀孕有关的死亡的一个例子是，如果一名妇女开始劳动，她患有产科出血，不幸的是死亡。由于怀孕，她死于特定状况。随着在死亡证明中加入此怀孕的复选框，这就是CDC或任何组织的努力来弄清楚哪些妇女实际遭受了与怀孕有关的死亡，所有这些妇女都被分组在一起，因此需要大量努力分类所有这些妇女，以找出哪些实际上是与怀孕有关的，而不是与怀孕相关，并确定其死亡的因果关系。
Rachel:	05:37	一旦该孕产妇死亡率审查委员会确定，它就会报告给他们的州一级。实际上只是自愿将其报告给国家一级。不同的州正在使用不同的定义，其团队中有不同的专家。国家如何对其进行分类之间没有太多一致性，有很多困惑。这些与妊娠有关的复选框以及2015年的ICD-9至10代码引起了人们对实际价格的关注。尤其是在德克萨斯州，他们实际上不小心膨胀了费率，因此他们不得不重新识别他们的数字是否确实准确。
Rachel:	06:29	So there’s a lot of inconsistencies, and in the last two years we’ve been exploring those data quality issues, but there’s a huge need for overall just more of an emphasis on how it’s defined, how it’s collected, how it’s stored, and how it’s disseminated for people who are trying to initiate change in this space understand what’s really happening. Because if you’re designing programming and you’re not looking at the data, how do you know you’re solving the right problem?
Cameron:	07:00	即使那样，我也提到很难将该数据归一化，因为它们可能会报告发生事情可能发生的各种原因。能够区分一个状态，显然是与怀孕有关的死亡，另一个状态只是与怀孕相关的死亡，能够在所有50个州中分解这两个状态将非常复杂。
Rachel:	07:21	是的。当您认为怀孕复选框时，必须做很多工作。不仅仅是看死因裁判官的报告。Some states are even going to social media, they’re going to anecdotes, they’re talking to family members to really determine what the causality of that death was and if in fact her death was preventable, because there’s a lot of different factors that can interplay into maternal mortality rather than, you know, X woman hemorrhaged. It’s a very complicated topic that deems across so many different public health issues.
Cameron:	07:56	And so from there, how did they take that data and in California come up with these kits?
Rachel:	08:01	在其孕产妇死亡审查委员会中，他们收集了X期限的数据，然后对其进行分类以找出与妊娠有关的死亡的主要原因是什么，并且就死亡而言，可以预防死亡，可以进行什么干预措施为了防止它们，他们将所有这些都纳入了解决这些问题的这些质量改进工具包中。因此，他们了解他们的人口，他们知道纠正这些错误所需的需要什么，并实施了这些错误并取得了成功。我认为整个国家需要从中学习，并将这种方法应用于所有其他州。
Cameron:	08:43	Maybe before we move on to MITRE’s role, you could give us a little more about what we might expect in this toolkit, because it’s not a literal toolkit.
Rachel:	08:50	正确的。每个人基本上都是可以给医院或临床医生的PDF，其中包括教育培训，临床方案。基本上，如果要解决学龄前儿童，那么关于前宾夕法尼亚之前应该知道的一切，应该围绕哪些教育以及应采取哪些干预措施来有效地对待它。
Cameron:	09:13	考虑到所有这些，MITER适合所有这些？
Rachel:	09:17	当然。A team of different federal agencies and organizations within the obstetrics and gynecology and maternal health space have teamed up to implement a program called the AIM bundles, which has toolkits of similar nature to California’s programming, that they’re trying to get different states to apply within their hospitals, but it’s done on a very different scale and it’s optional to institute these bundles. It’s too early to see the effectiveness of them. It’s done on such a finite scale of one hospital is doing it in this city, and one hospital is doing in that city, so we don’t understand yet the effectiveness of it. It’s very hard to understand the data behind that and apply it to other states, versus California has more numbers and data on the effectiveness of the toolkits and what would happen if it was widely dispersed and implemented.
Rachel:	10:21	Our MITRE research team developed the MITRE Maternal Mortality Interactive Dashboard, which we’ve coined us 3MID, 3 M-I-D. What it does is, in its nature, it’s an interactive dashboard. It allows the user to develop these what-if scenarios to see how different factors interact with one another to influence maternal mortality rates. .
Cameron:	10:47	In a dashboard like that, and it sounds like you would have a lot of representative data, how are you making sure that you don’t accidentally let anyone’s individual information get leaked? How do you protect the privacy of these women who are suffering?
Rachel:	11:01	当然。We’re using a synthetic population, which is a statistically significant reproduced population of a dataset.
Cameron:	11:09	要明确的是，这意味着它不是相同的数据集，但是它足够近，以至于从中收集到的任何东西都相当于从实际的民众那里收集的东西。
Rachel:	11:19	正确的。我们的样本量约为300万妇女。在每个仿真中，我们拉出一千个代表我们从中获取数据的数据集的女性。我们有这些妇女的人口统计因素，因此她们的种族，年龄，收入。它计算了他们遭受孕产妇死亡的潜力的风险评分，并考虑了他们所居住的县。
Cameron:	11:53	我意识到这里明显的目标是我们要减少孕产妇死亡率，但是当您推出此仪表板并让其他人访问它时，您希望用户能从这些工具中收集什么？
Rachel:	12:04	当然。By creating these what-if scenarios, we hope that policy makers can see how to most effectively allocate their resources. The successful implementation and use of these toolkits requires a lot of resources, and resources includes money. To know what areas are in the most need and to allocate those resources to the areas of most need to have the most effect, to impact the most lives, that’s the goal, is to know how to be smart and promote data-driven decision making.
Cameron:	12:39	Yeah, so it sounds like there’s really three things you’re achieving here. The first and most difficult is just showing that there is this problem, and that is a problem of getting good data, having it categorized, appropriately representing a problem or at least identifying what the pattern is. Then the second is how do you turn that data into a meaningful, actionable way of doing anything, which it sounds like the toolkit solves. This last point is we need the dashboard to say, “All right, we did the footwork. We found this is the data in California, this is a toolkit from California.” Now, is that data limited to California? If I’m in Florida, if I’m in Ohio, if I’m in Alaska, can I still glean similar ideas and results in terms of understanding who is underserved in my constituency or in my town, and being able to turn that into something actionable that helps those people out?
Rachel:	13:33	是的，这是一个很好的问题。现在，在3MID中，我们只有加利福尼亚和佐治亚州。我们从这两个状态下有关于运行这些模拟必要的数据的数据，但最终目标是拥有每个状态。但是，正如您可以想象的那样，每个州都是不同的，它们面临着不同的问题。重要的是要有特定数据考虑基础设施，文化以及农村与城市。有许多复杂的因素导致了特定州的公共卫生问题，最终导致了孕产妇死亡率。
Rachel:	14:18	我们现在正在努力建立合作伙伴关系以获取更多数据，以便我们可以拥有一个具有更多状态的工具，但需要时间。最终，我的意思是，这就是目标，每个州都能使用此仪表板来了解如何降低其孕产妇死亡率。
Cameron:	14:39	Can you walk us through an example of how this tool has been, or might be, used?
Rachel:	14:43	当然。如果一个决策者的资金如何分配，试图确定：“嘿，我有一百万美元。我想帮助孕产妇的健康计划。我想帮助降低我州的孕产妇死亡率，因为我们的率确实很高。我们该怎么做？”
Cameron:	15:00	是的。这可能是一个慈善机构，几乎所有有权力的人都可以做出这样的决定。
Rachel:	15:06	正确的。They need to understand their environment, they need to understand where the most need is and where their dollar spend would have the most impact. So they could use this tool to figure out within their state what counties are in the most need and the population within that county, because different maternal health conditions affect different races in different capacities.
Rachel:	15:32	例如，子痫前的影响黑人妇女的率高于白人妇女。假设您发现您所在州内的一个县的黑人人口较高，其前宾夕法尼亚州的人口很高，您可以说，好吧，我们知道他们应该使用此工具包。如果我们将此工具包应用于该人群，鉴于我们拥有的这笔钱，这可能会产生什么样的效果，以及与其他县的影响相比如何？这不是关于哪个县应有的，或者或那个。在资源有限的情况下，更多的是，我们在哪里可以改变最大的变化？
Cameron:	16:13	是的。我认为这是一种增长的趋势，即医疗保健中的数据（我们希望是预防性而不是反应性）。如果我们能看到在这些社区中有一些人口不足，如果我们只是花时间给他们提供我们负担得起的基本医疗服务，因为在这种情况下，我是否会发表这一说法？
Rachel:	16:31	Mm-hmm (affirmative).
Cameron:	16:33	Then, first of all, they won’t die, which is the most important thing, but they also won’t suffer. There won’t be those extra medical costs that come from when someone is sick and ends up in the hospital having to go through a situation that could affect them and follow them for the rest of their lives, however long that may be. That preventative care is obviously very beneficial.
Rachel:	16:53	Mm-hmm (affirmative).
Cameron:	16:55	我认为下一个最重要的问题是，好吧，您已经说服了我，我需要动手使用此工具。我们可以在哪里可以了解有关您的工作，您所取得的成就，如何获得此工具或门户网站的更多信息？
Rachel:	17:05	截至目前，我们有几个面向外部的出版物，任何人都可以读[或者手表]。我们在一些不同的会议上介绍了我们正在社交工具，弄清楚我们如何改善工具。不幸的是，该工具还没有准备好公开发布，但我们希望在明年左右，我们可以找到一种将其转换给联邦政府或行业合作伙伴的方法，以便我们可以推广以数据为导向的决策来最终降低孕产妇的死亡率，并希望又有孕产妇健康状况的种族差异。
Cameron:	17:42	好的。好吧，这是一次很棒的对话。我想对Miter和知识驱动的企业简要介绍，这使这次对话成为可能，并非常感谢您，雷切尔（Rachel）领导这项非常重要的工作。我很高兴看到有这些切实的结果，以至于您可以真正获得这些好处。非常感谢您的参与。
Rachel:	18:03	谢谢你，卡梅伦。