SPECIFIC AIMS (Overall). The goal of the proposed Multilevel Interventions to Advance Maternal Health Equity (MIRACLE) Center is to reduce pregnancy-related and pregnancy-associated maternal morbidity and mortality (PRAMM) disparities in African American, Hispanic, and rural populations through innovative and culturally rel- evant community-partnered effectiveness and implementation research. This Center will address the need for multilevel, community-centered, equity-focused interventions developed and tested with an emphasis on scala- bility and sustainment to address PRAMM disparities. The proposed MIRACLE Center is innovative because it: (1) tests complementary, multilevel pregnancy-to-postpartum interventions operating across multiple health sys- tems and settings; (2) addresses and measures a wide range of PRAMM conditions (including non-severe mor- bidity and pregnancy-associated mortality, which are less commonly measured), as well as severe maternal morbidity (SMM) and pregnancy-related mortality; (3) analyzes main effects within each project and synergistic effects across projects, which target different levels and sources of disparities; (4) uses a statewide linked Med- icaid dataset (claims, vital records, screening data) to evaluate common outcomes, allowing for data harmoni- zation across projects and with other Centers nationally; and (5) focuses on the understudied implementation science concepts of scale-up and sustainment. The Center is significant because it: (1) develops and tests novel approaches to addressing determinants of inequities at multiple levels and in multiple systems, (2) tests these population-level equity-focused interventions in 20 Michigan counties, covering a population of >7 million; and (3) uses an equitably partnered Center structure, with academic and health system or community PIs of the Center and of each component. All these features enhance utility and impact of the proposed work. Through three R01-scope projects implementing and testing multilevel interventions, and Community Partnership and Training Components the Center will accomplish the following Aims: (1) Evaluate effectiveness, cost-effective- ness, implementation, and population-wide impact of innovative and culturally relevant multilevel interventions to eliminate PRAMM disparities through three R01-scope projects; (2) Generate and scale innovative ap- proaches & partnerships for eliminating PRAMM disparities; (3) Maximize scalability, sustainability, cultural rel- evance, and broad dissemination of identified approaches; (4) Increase research, practice, and policy capacity for eliminating PRAMM disparities. This Center is rooted in a culturally informed multi-disciplinary Research Community with involvement of longstanding community, health, and policy partners in all phases of the Center’s work, and partnership with Black and Hispanic Medicaid-eligible mothers and their families in urban and rural settings. With in-kind financial support from academic and health institutions, the Center will generate scalable and sustainable approaches for saving maternal lives and ending preventable and unequal maternal suffering.

The goal of the proposed Multilevel Interventions to Advance Maternal Health Equity (MIRACLE) Center is to reduce pregnancy-related and pregnancy-associated maternal morbidity and mortality (PRAMM) disparities in African American, Hispanic, and rural populations through innovative and culturally relevant community- partnered effectiveness and implementation research. This Center will address the need for multilevel, com- munity-centered, equity-focused interventions for PRAMM disparities, which are developed and tested with an emphasis on scalability and sustainment.