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

项目总结 产后期--通常被称为“第四个三个月”--是妇女生活中迅速而剧烈变化的时期。 妇女及其家庭，以及在这一过渡期间接受保健对于优化妇女的长期保健至关重要 健康和她们随后怀孕的健康。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。相当可观 在卫生保健的接受、质量和结果方面存在种族/民族和社会经济差异。改善健康状况 对所有妇女来说，都需要发展新的、更全面的产后和 受孕期护理。一种潜在的模式可能是患者导航，这是一种专注于纵向、 以患者为中心的干预，为一套定义的健康服务提供支持。 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 患者导航计划改善了低收入女性的健康状况。我们之前 开发了一个产后患者导航程序，名为导航新母亲(NNM)，它 引入了临床层面的干预，由患者导航员承担产后支持和后勤工作 低收入妇女的责任。在这项观察性调查中，航海与 改善结果(护理保留、避孕用药、接种疫苗和抑郁症筛查) 与历史上的同龄人相比。我们现在建议测试最新的NNM模型的有效性- 被称为“NNM2”--通过随机试验。我们将随机抽查400名孕妇或产后公开- 为NNM2导航与常规护理提供资金的产前护理(1：1)。被随机分配到导航系统的女性 在产后12周内提供集中、个性化、一对一的导航服务，并基于 个性化需求，产后一年持续、渐进式导航。参与者将接受调查， 在产后4-12周和1岁时进行面谈和病历复查。 目标1将评估导航计划是否改善了产后4-12周的临床结局 通过健康状态的组合来衡量，包括保留在护理中，接受推荐咨询 (预见性指导)，接受期望的避孕措施，产后抑郁筛查和护理， 母乳喂养的启动和维持，以及接受指定的预防性护理。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 通过焦点小组和调查提供提供商体验。这项研究的完成将填补证据空白 论证产后导诊是否是改善妇女短小和肥胖的有效机制 长期健康，提高卫生保健利用率，并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.