Computer Assisted Support for Underserved Pregnant Women

描述（由申请人提供）：早产导致75%的新生儿死亡率和一半的儿童长期神经损伤，以及相当一部分与出生有关的短期和长期发病率。自1981年以来，早产率上升了27%。2001年，早产儿的比例增加到11.9%，这是至少20年来的最高水平，每年有44万多名新生儿出生。三个最大的种族/族裔群体的早产率都有所上升。在医疗服务不足和少数民族人群中，低出生体重婴儿的比例更高——即使考虑到医疗服务和保险覆盖等问题。早产儿占所有婴儿医疗保健支出的30%，占儿童医疗保健支出的10%。及时筛查和管理可改变的风险可以减少早产风险，提高孕产妇和儿童的生活质量。然而，提供有效的产前风险管理系统以满足医疗服务不足人群的独特需求是复杂的。本应用程序的目标是开发一个实用的、易于交付的、基于证据的计算机辅助干预系统，以筛查和帮助医疗服务不足的孕妇及其医疗保健提供者（HCPs）管理与早产风险增加相关的可修改条件。（医护人员将利用这一系统对这些患者进行咨询，让患者了解女性可以做出的降低风险的改变，并在需要时进行转诊。）在第一阶段，我们将为西班牙裔和非裔美国人开发评估和干预材料（在文化和语言上都是合适的），完成计算机编程，并在常规的第一或第二孕期产前护理诊所访问期间进行可接受性测试。20名非裔美国妇女和20名西班牙裔妇女将从门诊随机选择完成一个即时和短期的可接受性测试。医生、护士、助产士和医疗机构经理也将提供可接受性数据。如果第一阶段的可接受性测试成功，PHCC LP将提交第二阶段有效性试验的申请，以进一步完善和测试该系统。

DESCRIPTION (provided by applicant): Preterm births are responsible for 75 percent of neonatal mortality and one-half of long-term neurological impairments in children as well as a substantial portion of all birth-related short- and long-term morbidity. The preterm birth rate has risen 27 percent since 1981. The percent of preterm infants increased to 11.9 percent for 2001, the highest level in at least two decades accounting for more than 440,000 births annually. Preterm rates rose for each of the three largest racial/ethnic groups. Rates of low birth weight babies are higher in medically underserved and minority populations-even when issues such as access and insurance coverage are accounted for. Preterm births account for 30 percent of all health care spending on infants and 10 percent of spending for children. Timely screening and management of modifiable risks can reduce preterm birth risks and improve maternal and child quality of life. However, providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. The goal of this application is to develop a practical and easily delivered, evidence-based, computer-assisted intervention system to screen and assist medically underserved pregnant woman and their healthcare providers (HCPs) in managing modifiable conditions associated with increased risks of preterm births. (The HCPs will utilize this system with these patients to counsel patients on risk reduction changes the woman can make and refer when needed.) During Phase I, we will develop assessment and intervention materials (culturally and linguistically appropriate) for both Hispanic and African-American populations, complete computer programming and conduct acceptability testing during a routine 1st or 2nd trimester) prenatal care clinic visit. 20 African- American women and 20 Hispanic women will be randomly selected from outpatient clinics to complete an immediate and a short-term acceptability test. Physicians, nurse midwives and healthcare organization managers will also provide acceptability data. If Phase I acceptability tests are successful, PHCC LP will submit an application for a Phase II efficacy trial to further refine and test this system.