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

患者导航可改善低收入女性产后的结局

基本信息

批准号：
10201698
负责人：
Lynn M Yee
金额：
$ 65.57万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10201698
关键词：
American College of Obstetricians and Gynecologists Black race Breast Feeding Caring Chronic Clinic Clinical Communication Contraceptive methods Counseling Depression screen Development Diabetes Mellitus Effectiveness Emotional Ethnic Origin Evaluation Family Focus Groups Frequencies Funding Glucose tolerance test Health Health Services Health Status Healthcare Healthcare Systems Hispanics Individual Insurance Intervention Interview Investigation Life Logistics Low income Maintenance Maternal Age Measures Medicaid Medical Medical Care Team Medical Records Methods Minority Modeling Not Hispanic or Latino Outcome Participant Patient Outcomes Assessments Patients Perception Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women Premature Birth Prenatal care Prevention Preventive care Primary Care Physician Primary Health Care Process Professional Organizations Provider Psyche structure Race Randomized Research Risk Self Efficacy Services Social Change Social support Socioeconomic Status Surveys Text Messaging Time United States United States Dept. of Health and Human Services Update Vaccination Visit Weight Woman Women&apos s Health base care outcomes clinical care cohort comorbidity disparity reduction efficacy testing experience fourth trimester health care service utilization health disparity improved improved outcome mHealth motherhood patient oriented postpartum care postpartum health pregnancy health primary outcome programs racial and ethnic disparities randomized trial satisfaction socioeconomic disparity treatment as usual uptake

项目摘要

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.

项目摘要产后时期（通常称为“第四学期”）是一个快速而急剧变化的时期妇女和她的家人以及在此过渡期间对医疗保健的吸收对于优化妇女的长期至关重要健康及其随后怀孕的健康。产后护理的重要性已得到加强在专业组织中，美国的产后护理仍然不足。重大的医疗保健吸收，质量和结果的种族/种族和社会经济差异。改善健康对于所有妇女，都需要开发新的，更全面的产后方法相互作用护理。一个潜在的模型可以是患者导航，这是一个以屏障为中心的，纵向的导航，以患者为中心的干预措施，为一组定义的卫生服务提供支持。该提案总结了一项为期5年的研究计划，以评估是否实施产后患者导航计划改善了低收入妇女的健康状况。我们以前制定了产后患者导航计划，称为新母性（NNM），该计划引入了诊所水平的干预措施，其中患者导航员假定产后支持和后勤低收入妇女的责任。在这项观察性调查中，导航与改善结局（保留护理，避孕摄取，疫苗接种和抑郁筛查）与历史人群相比。现在，我们建议测试更新的NNM模型的效率 - 称为“ NNM2” - 通过随机试验。我们将随机将400名孕妇或产后妇女与公开与NNM2导航相对于常规护理，资助的产前护理（1：1）。随机导航的妇女将是在产后12周之前，提供密集的，个性化的一对一导航服务，并基于在产后一年的个人需求，持续的锥形导航。参与者将接受调查，访谈和产后4-12周和1年的病历审查。 AIM 1将评估导航计划是否在产后4-12周改善临床结果为通过健康状况的复合衡量，包括保留护理，收到推荐的咨询（预期指导），收到所需的避孕，产后抑郁筛查和护理，母乳喂养计划和维护，并获得指示的预防保健。 AIM 2将评估是否 NNM2使用定性和定量方法改善了患者报告的结果。 AIM 3将评估提供者通过焦点小组和调查经验。这项研究的完成将填补证据差距证明产后患者导航是否是改善妇女短期和妇女的有效机制长期健康，促进医疗保健利用，并提高患者和提供者的满意度。