Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.
Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.
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减少产后护理利用的差异：临床风险评估工具的开发。
DOI：
10.1111/jmwh.13461
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Garfield,Lindsey
中科院分区：
文献类型：
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作者：
Tenfelde,Sandi;Joyce,Cara;Tell,Dina;Masinter,Lisa;Wallander-Gemkow,Jena;Garfield,Lindsey
在联邦卫生中心接受护理的患者的产后护理出勤率很低。围产期发病率和死亡率不成比例地影响低收入患者，并且可能是可以预防的。本研究的目的是开发一种临床决策支持工具，以确定不太可能返回产后护理的CIMHC患者。为了实现这一目的，我们评估了我们的患者population.MethodsThis已建立的预测因子和新的风险因素是一个回顾性的，二次数据分析的50,022例患者谁接受产前护理过去24周的妊娠在2012年和2017年之间的THEHC。使用医疗保健有效性数据和信息集指标将产后访视定义为早期护理（出生至21天）和后期护理（21 - 84天）。安德森的行为模式获得医疗保健指导纳入潜在的预测因素。我们分层数据的产后护理出勤率，最终的预测模型被选定的模型拟合统计和临床relevance.ResultsIn我们的样本中，64%的分娩的人参加产后护理在WATHCs。在返回护理的人中，38%在出生后21天内返回，62%在21至84天之间返回，28%在早期和后期护理中返回。产后护理的预测因素包括产妇年龄、产次、首次就诊时的胎龄和产前护理次数。一个临床决策支持工具，用于识别患者不太可能返回护理created.DiscussionAn易于实施的临床决策支持工具，可以帮助确定产后不出席的风险的CIMHC患者。未来的干预措施，以提高产前护理的充分性，可以鼓励早期进入产前护理和足够的产前检查。这些努力可能会改善产后护理出勤率和孕产妇健康。
IntroductionPatients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low‐income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population.MethodsThis is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks’ gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21‐84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance.ResultsIn our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created.DiscussionAn easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.