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

项目摘要 在美国，孕产妇死亡率和严重孕产妇发病率自1990年以来有所上升 严重的种族和族裔差异依然存在。在全国范围内，近70%的妊娠相关死亡 发生在产后期间。尽管越来越多的证据表明产后护理对 由于不平等现象加剧，许多妇女得不到推荐的护理。事实上，严重的种族/民族差异 接受产后护理可能是造成孕产妇健康差距的一个主要因素。目前大多数 产后护理是零散的，范围有限，使许多妇女得不到充分的保健， 行为健康护理和社会支持。我们的初步工作表明，妇女对一个 产后护理可以与儿科护理一起提供的护理模式。从我们的研究中，我们 创建了一个综合的两代诊所，在那里产后护理与儿科护理一起提供， 向家庭提供社会支持和行为健康服务。我们的护理模式解决的问题， 造成孕产妇发病率和死亡率的因素，包括健康的社会决定因素， 条件和心理健康。目前，这种集成的两代模式是在一个医院为基础的 诊所，一个不太可能接触到绝大多数分娩者的环境。因此，使用实现 框架，我们建议评估目前的综合两代模型的成功组件， 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因素 多样化社区卫生中心的样本，并完善护理模式，以满足社区的需求 这些健康中心照顾那些经历持续不平等的妇女。

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.