Interprofessional Perinatal Consults to Improve Communication Quality, Satisfaction, and Team Cohesion: A Randomized Controlled Trial of the Collaboration for Antepartum Risk Evaluation (CARE) Model

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PROJECT ABSTRACT/SUMMARY Perinatal outcomes in the United States rank below many other developed countries. National organizations, such as the American College of Obstetricians and Gynecologists, have called for women to utilize the level and provider of maternity services that meet their personal and medical needs. This leveled approach to care requires consultation and collaboration among providers to ensure women receive appropriate services. While national and international organizations have called for team-based maternity care, current models can fragment services, increasing the risk of communication errors. Women can feel disenfranchised by models that do not meet their needs and opt out of beneficial services altogether. Currently, there is not evidence on effective interdisciplinary models of maternity care. The Collaboration for Antepartum Risk Evaluation (CARE) study will use a randomized design to systematically test the effect of interdisciplinary consults on women and providers. The two aims of the study are: (1) evaluate the effect of collaborative vs individual consults on participant outcomes including communication quality (using the Communication Assessment Tool, team version), maternal satisfaction (using a modified Satisfaction with Prenatal Care measure), semi-structured interviews, adherence to the developed plan of care, and perinatal outcomes; (2) evaluate the effect of the CARE clinic on providers using the Communication Assessment Tool team version, the AHRQ TeamSTEPPS Teamwork perceptions questionnaire, and semi-structured interviews. The award will support three years of research, training, and mentoring to assist Dr. Phillippi in becoming an independent investigator in patient- centered health services research. The career development plan will expedite independence by increasing her knowledge of: (1) design and conduct of implementation research, (2) maternal-child and interdisciplinary health research, and (3) comparative effectiveness methods and measures to test patient-centered care and communication. The plan includes research on the CARE model, targeted coursework, training in responsible conduct of research, and structured mentoring. Dr. Phillippi's interdisciplinary mentorship team includes national leaders in health services, implementation, and women's health research as well as experts in biostatistics and publication. These diverse and experienced mentors will meet regularly with Dr. Phillippi to provide guidance. Vanderbilt has a wealth of resources for new investigators including lectures, research communities, and expert assistance, resulting in a K to R (equivalent) conversion rate of 72%. Vanderbilt's extensive digital infrastructure, including an integrated electronic medical records system and a secure, HIPAA-compliant research platform, facilitate health services research. The CARE study will provide valuable information on effective models for patient-centered maternity care. The AHRQ K08 will allow Dr. Philippi to implement the CARE study and facilitate her growth into a national leader in midwifery and health services research.