Improving Maternal Health Through an Adaptation of a Two-Generation Postpartum Care Model in Diverse Settings

项目摘要 在美国，产妇死亡率和严重产妇发病率自1990年以来一直在上升 严重的种族和民族差距依然存在。在全国范围内，近70%的妊娠相关死亡 发生在产后时期。尽管越来越多的证据表明产后护理对 为了改善不平等现象，许多妇女得不到建议的护理。事实上，严重的种族/民族差异 接受产后护理可能是造成产妇健康差距的一个重要因素。目前，大多数 产后护理支离破碎，范围有限，使许多妇女得不到适当的卫生保健， 行为保健和社会支持。我们的初步工作表明，女性对 产后护理可与儿科护理一起提供的护理模式。从我们的研究中了解到，我们 创建了一个整合的两代诊所，在那里提供产后护理和儿科护理， 并为家庭提供社会支持和行为健康服务。我们的护理模式解决了以下问题 导致产妇发病率和死亡率，包括健康的社会决定因素、潜在的医疗保健 条件和心理健康。目前，这种集成的两代模式是以医院为基础的 诊所，这是一个不太可能到达绝大多数分娩者的环境。因此，使用实现 框架，我们建议评估当前集成的两代模式的成功组件 护理，了解在全国范围内实施这一护理模式的潜在障碍和促进者 抽样不同的社区卫生中心，细化护理模式，满足社区需求 照顾持续存在差异的妇女的健康中心。

Project Summary In the United States, the rates of maternal mortality and severe maternal morbidity have increased since 1990 and significant racial and ethnic disparities persist. Nationally, almost 70% of pregnancy-associated deaths occur during the postpartum period. Despite the growing evidence of the importance of postpartum care to improve inequities, many women do not receive recommended care. Indeed, significant racial/ethnic disparities in receipt of postpartum care may likely be a strong contributor to maternal health disparities. Currently, most postpartum care is fragmented and limited in scope leaving many women without adequate health care, behavioral health care and social support. Our preliminary work demonstrated that women are interested in a model of care where postpartum care can be provided with pediatric care. Learning from our research, we created an integrated Two-Generation clinic where postpartum care is delivered alongside pediatric care, and families are offered social support and behavioral health services. Our care model addresses issues that contribute to maternal morbidity and mortality, including social determinants of health, underlying medical conditions, and mental health. Currently, this Integrated Two-Generation model is within a hospital-based clinic, a setting not likely to reach the vast majority of birthing persons. As such, using an implementation framework we propose to evaluate successful components of the current integrated Two-Generation model of care, understand potential barriers and facilitators to implementation of this care model among a national sample of diverse community health centers, and refine the model of care to meet the needs of community health centers that are caring for women who experience persistent disparities.