Service Delivery Models to Reduce Maternal and Child Health Disparities

描述(由申请人提供)：哥伦比亚特区长期以来的妊娠结局糟糕得令人无法接受，因为指标显示，婴儿死亡率、早产儿、低出生体重和极低出生体重的比率非常高。哥伦比亚特区的儿童患呼吸系统问题(特别是哮喘)、超重以及语言和认知发育迟缓的风险增加。对于大多数家庭来说，哥伦比亚特区家庭的医疗保健和社会服务是分散的、复杂的、经常变化的，而且不是以社区为基础的。一个值得注意的例外是发展中家庭中心，这是一种为孕妇、儿童和父亲提供多项服务、高度创新和反应迅速的护理形式。这项应用的重点是如何建设研究能力，然后就有前景的服务提供方法进行科学探索，以改善以低收入家庭为主的市中心、非裔美国人的健康和福祉。具体目标是：1)扩大和评估社区-大学研究伙伴关系，旨在增进对市中心家庭健康的了解；2)实施关于产前、分娩、产后和儿科护理、社会服务和支持以及儿童早期发展的计算机化信息系统；3)完善和开发创新、有效的方法来研究健康差距；纳入地方、文化和种族观点；4)就共同感兴趣的健康差距专题进行一系列描述性研究--包括与发展中家庭中心、孕妇及其家庭的福祉和服务提供经验有关的邻里知识和看法的研究1和侧重于孕期间隔以及与母亲、父亲和幼儿的积极健康和幸福指标相关的因素的研究2；5)传播我们伙伴关系的研究结果并记录这些研究结果的使用；以及6)与其他创新的(非传统的)社区服务提供者合作，创建一个进行多地点研究试验的网络。总体而言，我们寻求建立一种伙伴关系，促进对新知识(研究成果)的接受，以及在社区服务提供和服务提供研究方面的创新。

DESCRIPTION (provided by applicant): The District of Columbia has long had unacceptably poor pregnancy outcomes, as indexed very high rates of infant mortality, prematurity, low birth weight, and very low birth weight. Children in the District of Columbia are at elevated risk for respiratory problems (especially asthma), overweight, and developmental delays in language and cognition. For most families, health care and social services for families in the District of Columbia are fragmented, complicated, frequently changing, and not neighborhood-based. A notable exceptional is the Developing Families Center, a multi-service, highly innovative, and responsive form of care for pregnant women, children, and fathers. This application focuses on how to build research capacity and then conduct scientific inquiry about promising service delivery approaches to improve the heath and well-being of inner city, African American, predominately low income families. The specific aims are to: 1) expand and evaluate a community-university research partnership designed to advance knowledge about health of inner city families; 2) implement a computerized information system regarding prenatal, birth, post- partum, and pediatric care; social services and supports, and early child development; 3)refine, and develop innovative, valid methods to study health disparities; to incorporate local, cultural, and ethnic perspectives; 4) conduct a series of descriptive studies on health disparities topics of mutual interest -including Study 1 on neighborhood knowledge and perceptions related to the Developing Families Center, well-being of pregnant women and their families, and experiences with service delivery and Study 2 focused on the inter-pregnancy interval and factors associated with positive health and well-being indicators for mothers, fathers, and young children; 5) to disseminate research findings from our partnership and document the use of these findings; and 6) work with other innovative (non-conventional) community-based service providers to create a network for conducting multi-site research trials. Overall, we seek to create a partnership that will promote both receptivity to new knowledge (research findings) and innovation in community service delivery and research on service delivery.