权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Identifying and Addressing Opportunities in Primary Care to Improve Healthy Birth Intervals

识别和利用初级保健机会以改善健康出生间隔

基本信息

批准号：
10471325
负责人：
Debra Stulberg
金额：
$ 20.31万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-17 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10471325
关键词：
Achievement Address Administrator Affect Age Behavior Birth Birth Intervals Caring Chronic Care Clinical Clinical Trials Contraceptive Agents Contraceptive Usage Contraceptive methods Counseling Development Education Educational Background Educational Intervention Engineering Face Failure Family Family Planning Female Future General Practitioners Gynecologist Health High Risk Woman Intervention Lead Link Low income Measurable Measures Medical Methodology Mothers National Institute of Child Health and Human Development Nurses Office Visits Outcome Patients Pharmaceutical Preparations Physicians Poverty Preconception Care Pregnancy Pregnancy Interval Pregnancy Outcome Premature Birth Primary Health Care Process Reporting Research Research Project Grants Risk Risk Assessment Risk Factors Services Structure System Teratogens Testing United States Visit Woman Work World Health Organization acute care adverse maternal outcomes adverse pregnancy outcome care delivery care providers design effectiveness implementation study effectiveness trial high risk high risk population implementation evaluation implementation science improved infant outcome intervention delivery maternal morbidity maternal risk novel patient oriented prepregnancy primary care setting reproductive rural area success support tools tool treatment as usual user centered design

项目摘要

ABSTRACT Approximately 30% of pregnancies in the United States occur after a short interpregnancy interval (IPI) <18 months. Short IPI is associated with adverse maternal and infant outcomes, especially among women from high-risk populations. Primary care offers an opportunity to engage and educate reproductive age patients about birth spacing, provide preconception and contraceptive care between pregnancies (“interconception” care) and coordinate their acute and chronic care needs. Groups with higher risks of adverse pregnancy outcomes, such as low-income women, are more likely to receive their reproductive care from a primary care provider (PCP) than an obstetrician-gynecologist. Three quarters of reproductive age women in the United States have at least one physician visit each year, most commonly with their PCP; however, only 14% of office visits involve preconception or contraceptive care. Many PCPs already feel task-saturated when delivering primary care and face numerous barriers to providing high-quality interconception care. Although some interventions appear to be effective, attempts to improve preconception/interconception care, within primary care, have had limited success. We hypothesize that this may be due to inadequate design for sustainable implementation into clinical workflows. This developmental study will therefore gather key stakeholders (e.g. primary care clinicians, nurses, practice administrators and staff) and female reproductive age patients at three diverse primary practices to take part in a failure modes effects and criticality analysis (FMECA). This risk assessment engineering methodology will allow us to fully characterize and understand the failures/missed opportunities in the systems and processes of primary care to deliver interconception care. We will then apply an iterative user-centered design approach, building from existing interventions and from the FMECA results, to create a novel intervention for integrating effective, patient-centered interconception care into primary care. In future work, we intend to test this novel intervention using a type II hybrid implementation/effectiveness trial.

摘要在美国，大约30%的怀孕发生在短的解释间隔（IPI）<18 个月短的IPI与不良的母婴结局相关，特别是在来自高危人群。初级保健提供了一个机会，让育龄患者参与并接受教育关于生育间隔，提供孕前保健和怀孕之间的避孕保健（“怀孕期间”）护理），并协调他们的急性和慢性护理需求。不良妊娠风险较高的群体结果，如低收入妇女，更有可能从初级保健中获得生殖保健提供者（PCP）而不是妇产科医生。美国四分之三的育龄妇女各州每年至少有一次医生就诊，最常见的是他们的PCP;然而，只有14%的办公室访问涉及孕前或避孕护理。许多PCP在交付时已经感到任务饱和初级保健和面临许多障碍，提供高质量的怀孕期间的护理。尽管一些干预措施似乎是有效的，试图改善孕前/怀孕期间的照顾，在初级但是，成功有限。我们推测，这可能是由于可持续发展的设计不足，应用到临床工作流程中。因此，这项发展研究将聚集关键利益相关者（例如，初级保健临床医生、护士、实践管理人员和工作人员）和育龄女性患者，不同的主要实践参与故障模式影响和危害性分析（FMECA）。这种风险评估工程方法将使我们能够充分描述和了解故障/遗漏在初级保健系统和过程中提供孕期保健的机会。然后我们将申请一种迭代的以用户为中心的设计方法，基于现有的干预措施和FMECA结果，创造一种新的干预措施，将有效的、以病人为中心的孕期护理纳入初级保健。在未来的工作中，我们打算使用II型混合实施/有效性试验来测试这种新的干预。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Preconception, Interconception, and reproductive health screening tools: A systematic review.

DOI：
10.1111/1475-6773.14123
发表时间：
2023-04
期刊：
HEALTH SERVICES RESEARCH
影响因子：
3.4
作者：
Ren, Megan;Shireman, Hannah;VanGompel, Emily White;Bello, Jennifer K.;Carlock, Francesca;McHugh, Ashley;Stulberg, Debra
通讯作者：
Stulberg, Debra

Corrigendum to "Preconception, interconception, and reproductive health screening tools: A systematic review".

“孕前、避孕和生殖健康筛查工具：系统评价”的更正。