Predicting Postpartum Transition to Primary Care in Community Health Centers.
Predicting Postpartum Transition to Primary Care in Community Health Centers.
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DOI：
10.1016/j.amepre.2022.05.010
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发表时间：
2022-11
影响因子：
5.5
通讯作者：
Masinter, Lisa
中科院分区：
文献类型：
--
作者：
Gemkow, Jena Wallander;Liss, David T.;Yang, Ta-Yun;Padilla, Roxane;King, Patricia Lee;Pereyra, Susan;Cox-Batson, Stephanie;Tenfelde, Sandi;Masinter, Lisa
虽然常规产后护理后过渡到初级保健已被建议，以减轻不利的产妇结局，很少有人知道现实世界的过渡模式。本研究的目的是描述在联邦合格的卫生中心接受护理的产后队列和临床高风险患者的子队列中过渡的模式和预测因素。于2021年分析2017年至2019年期间收集的电子健康记录数据，以进行全面及高风险队列的未经调整分析及多变量回归模型。主要结局是在分娩后6个月内完成初级保健就诊。两个队列的主要预测因素是保险损失、产后访视、孕早期访视和孕前一年内的医疗访视;对于整个队列，还研究了高风险状态。全队列（N= 7，926）分析显示，17.3%完成了初级保健访视。在未校正和校正分析中，所有5个预测因子均与初级保健访视完成显著相关; 25.0%的高危患者完成了初级保健访视，失去保险的患者完成初级保健访视的几率降低66%（95% CI=0.24，0.48）。在高危队列（n= 1，956，全队列的24.7%）的未校正和校正分析中，除产后访视外，所有预测因素均与初级保健访视完成显著相关。在联邦合格的卫生中心的产后病人过渡到初级保健率低，保险损失是一个重大的障碍，以照顾。应研究提高连续性的战略，包括改善获得保险的机会。未来的研究需要研究结构性不平等，初级保健对孕产妇结局的影响，以及患者的经验。
Although the transition to primary care after routine postpartum care has been recommended to mitigate adverse maternal outcomes, little is known about real-world transition patterns. The objective of this study was to describe the patterns and predictors of transition in a postpartum cohort receiving care at federally qualified health centers and a subcohort of clinically high-risk patients. Electronic health record data collected between 2017 and 2019 were analyzed in 2021 for unadjusted analyses and multivariable regression models for both the full and high-risk cohorts. The primary outcome was completion of a primary care visit within 6 months of delivery. Primary predictors in both cohorts were insurance loss, postpartum visit, first-trimester visit, and medical visit within the year prepregnancy; for the full cohort, high-risk status was also studied. The full cohort (N=7,926) analysis showed that 17.3% completed a primary care visit. In unadjusted and adjusted analysis, all 5 predictors were significantly associated with primary care visit completion; 25.0% of high-risk patients completed a primary care visit, and patients who lost insurance had 66% lower odds of primary care visit completion (95% CI=0.24, 0.48). In unadjusted and adjusted analysis for the high-risk cohort (n=1,956, 24.7% of full cohort), all predictors except postpartum visit were significantly associated with primary care visit completion. Postpartum patients at federally qualified health centers transitioned to primary care at low rates; insurance loss was one significant barrier to care. Strategies to increase continuity, including improving insurance access, should be studied. Future research is needed to study structural inequity, the impact of primary care on maternal outcomes, and patient experience.
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