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

项目总结

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.