Colorado Nurse Family Heart Trial for the ENRICH program

项目摘要 心血管疾病（CVD）是美国的主要死亡原因， 种族/少数民族和低收入个人。心血管疾病的风险在生命的早期就开始了， 关键时期（胎儿发育、婴儿期和生育期）的暴露改变了健康轨迹 走向明显的疾病。因此，从怀孕开始促进和维持心血管健康（CVH）的努力 对于减少CVD的代际负担至关重要。为了响应早期干预， 母亲和儿童心血管健康申请（ENRICH RFA），我们建议利用 两种广泛可用的干预措施，以促进不同的，资源不足的孕妇和后代的CVH： 护士家庭伙伴关系（NFP）和国家糖尿病预防计划（NDPP）。NFP是一种家访 一项护士从怀孕到产后24个月为初次怀孕、资源不足的母亲提供支持的计划 改善产前结果、儿童安全和发展结果以及经济自给自足。NFP是 在全国超过260个组织中提供，包括我们的丹佛健康合作伙伴，他们已经将其交付给超过2400个组织。 自2000年以来，城市资源不足的妇女。虽然NFP解决了一些公认的原因， 在孕产妇和儿童保健方面，CVH尚未得到全面处理或评估。因此，我们建议 通过改编自NDPP的以CVH为重点的规划来加强NFP，NDPP是一种为期一年的循证生活方式 促进健康饮食和活动的干预措施，以减轻体重，精神障碍和其他CVD风险， 自2013年以来，我们已经为丹佛健康中心的1600多名不同的、资源不足的成年人提供了服务，其中包括340多名年轻人。 妇女通过利用NFP的独特优势（家庭交付模式，专业护理支持， 健康的社会决定因素[SDOH]）与NDPP（CVH促进的循证内容）， 在ENRICH计划中严格评估的联合干预（NFP-心脏）具有很大的改善潜力， 资源不足人群的CVH结局。我们的科罗拉多护士家庭心脏试验将评估NFP-心脏 在10家诊所招募的600名未生育妇女（及其后代）中， 在一个安全网，城市医疗系统中。NFP-Heart将通过编程促进代际CVH 从怀孕20周到产后24个月由家访护士接生。我们的具体目标是：（1） 制定本地NFP-心脏和通用ENRICH方案，并进行试点研究以确认可行性， 可接受性; 2）评价NFP-心脏对母体和后代CVH指标的影响; 3）评估 SDOH对NFP-心脏干预对母体和后代CVH结局的影响的修正;以及 4)检查NFP心脏干预的实施情况和使用混合的可持续性的潜力， 方法论。

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death in the United States, with disparately greater impact on racial/ethnic minorities and lower-income individuals. Risk for CVD begins very early in life as adverse exposures during critical periods (fetal development, infancy, and reproductive years) shift the health trajectory toward overt disease. Thus, efforts to promote and maintain cardiovascular health (CVH) from pregnancy onward are crucial to reducing the intergenerational burden of CVD. In response to the Early Intervention to Promote Cardiovascular Health of Mothers and Children request for applications (ENRICH RFA), we propose to leverage two widely-available interventions to promote CVH in diverse, under-resourced pregnant women and offspring: Nurse Family Partnership (NFP) and the National Diabetes Prevention Program (NDPP). NFP is a home visiting program in which nurses support first-time, under-resourced mothers from pregnancy to 24 months postpartum to improve prenatal outcomes, child safety and developmental outcomes, and economic self-sufficiency. NFP is available at >260 organizations nationwide, including our Denver Health partners who have delivered it to >2400 urban, under-resourced women since 2000. While NFP addresses some putative causes of compromised maternal and child health, CVH has not been comprehensively addressed nor evaluated. Thus, we propose to enhance NFP with CVH-focused programming adapted from the NDPP, a yearlong, evidence-based lifestyle intervention that promotes healthy eating and activity to reduce weight, dysglycemia, and other CVD risks, which we have delivered to >1600 diverse, under-resourced adults at Denver Health since 2013, including >340 young women. By leveraging unique strengths of NFP (home delivery model, professional nursing support, impact on social determinants of health [SDOH]) with those of NDPP (evidence-based content for CVH promotion), a combined intervention (NFP-Heart) rigorously evaluated in the ENRICH program has great potential to improve CVH outcomes in under-resourced populations. Our Colorado Nurse Family Heart Trial will evaluate NFP-Heart versus usual care among 600 nulliparous women (and their offspring) recruited in early pregnancy from 10 clinics in a safety-net, urban healthcare system. NFP-Heart will promote intergenerational CVH with programming delivered from 20 weeks gestation to 24 months postpartum by home visiting nurses. Our specific aims are 1) develop the local NFP-Heart and common ENRICH protocols, and conduct pilot studies to confirm feasibility and acceptability; 2) evaluate the effect of NFP-Heart on maternal and offspring CVH metrics; 3) assess the degree to which SDOH modify the effect of the NFP-Heart intervention on maternal and offspring CVH outcomes; and 4) examine the implementation of the NFP-Heart intervention and potential for sustainability using a mixed- methods approach.