Patient navigation to improve outcomes among low-income women in the postpartum period

项目摘要 产后时期-通常被称为“第四个三个月”-是一个快速和激烈的变化在生活中的时间， 妇女和她的家庭，在这一过渡期间获得保健服务对优化妇女的长期保健至关重要。 健康和以后怀孕的健康。产后护理的重要性得到了加强 然而，美国的产后护理仍然不足。实质性 在卫生保健的接受、质量和结果方面存在种族/族裔和社会经济差异。完善健康 需要制定新的、更全面的方法， 孕期护理一种潜在的模型可以是患者导航，其是以障碍为中心的纵向的， 以患者为中心的干预，为一套确定的卫生服务提供支持。 这项建议总结了一项为期5年的研究计划，以评估是否实施产后 病人导航计划改善了低收入妇女的健康状况。我们之前 开发了一个产后患者导航程序，称为导航新的母亲（NNM）， 引入了一个临床层面的干预，其中病人导航员承担产后支持和后勤 对低收入妇女的责任。在这项观察性研究中，导航与 改善结局（继续护理、避孕、接种疫苗和抑郁症筛查） 与历史同期相比。我们现在建议测试更新后的NNM模型的有效性- 称为“NNM 2”--通过一项随机试验。我们将随机抽取400名孕妇或产后妇女- 受资助的产前护理与NNM 2导航对比常规护理（1：1）。随机分配至导航组的女性将 在产后12周内提供密集、个性化、一对一的导航服务， 个性化需求，持续，产后一年的锥形导航。参与者将接受调查， 在产后4-12周和1年时进行访谈和病历审查。 目标1将评价导航程序是否改善了产后4-12周的临床结局， 通过健康状况的复合指标来衡量，包括继续接受护理、接受建议的咨询 （预期指导），接受所需的避孕措施，产后抑郁症筛查和护理， 开始和维持母乳喂养，并接受指定的预防性护理。目标2将评估是否 NNM 2使用定性和定量方法改善患者报告的结局。目标3将评估 通过焦点小组和调查提供经验。本研究的完成将填补证据空白， 证明产后患者导航是否是改善女性短期和长期生活的有效机制。 长期健康，提高卫生保健利用率，提高患者和提供者的满意度。

PROJECT SUMMARY The postpartum period – often called the “fourth trimester” – is a time of rapid and intense change in the life of a woman and her family, and uptake of health care during this transition is critical to optimizing women's long-term health and the health of their subsequent pregnancies. The importance of postpartum care has been reinforced by professional organizations, yet postpartum care in the United States remains inadequate. Substantial racial/ethnic and socioeconomic disparities in health care uptake, quality, and outcomes exist. Improving health for all women requires the development of new, more comprehensive approaches to postpartum and interconception care. One potential model may be patient navigation, which is a barrier-focused, longitudinal, patient-centered intervention that offers support for a defined set of health services. This proposal summarizes a 5-year research plan to evaluate whether implementation of a postpartum patient navigation program improves health outcomes among low-income women. We previously developed a postpartum patient navigation program, called Navigating New Motherhood (NNM), which introduced a clinic-level intervention in which a patient navigator assumed postpartum supportive and logistical responsibilities for low-income women. In this observational investigation, navigation was associated with improvements in outcomes (retention in care, contraception uptake, vaccination, and depression screening) compared to those of a historical cohort. We now propose to test the efficacy of the updated NNM model – called “NNM2” – via a randomized trial. We will randomize 400 pregnant or postpartum women with publicly- funded prenatal care to NNM2 navigation versus usual care (1:1). Women randomized to navigation will be provided intensive, individualized, one-on-one navigation services through 12 weeks postpartum and, based on individual needs, ongoing, tapered navigation through one year postpartum. Participants will undergo surveys, interviews, and medical record review at 4-12 weeks and 1 year postpartum. Aim 1 will evaluate whether the navigation program improves clinical outcomes at 4-12 weeks postpartum as measured via a composite of health status that includes retention in care, receipt of recommended counseling (anticipatory guidance), receipt of desired contraception, postpartum depression screening and care, breastfeeding initiation and maintenance, and receipt of indicated preventive care. Aim 2 will evaluate whether NNM2 improves patient-reported outcomes using both qualitative and quantitative methods. Aim 3 will evaluate provider experiences via focus groups and surveys. Completion of this study will fill an evidence gap by demonstrating whether postpartum patient navigation is an effective mechanism to improve women's short- and long-term health, enhance health care utilization, and improve patient and provider satisfaction.