The OPTIMIZE Study: Optimizing Patient Navigation for Perinatal Care

美国母婴结局中持续和恶化的种族和民族差异迫在眉睫 公共卫生问题。非裔美国人(AA)女性早产的风险大约是前者的两倍，而且更低 出生体重与非西班牙裔白人女性相比，更容易出现并发症 怀孕和严重的孕产妇发病率。随着这些差距的加剧，人们重新关注 围产期护理。围产期，即出生前和出生后的几周，对女性的 以及她孩子的健康。不幸的是，流行的围产期标准护理模式已经停滞不前了 几十年，没有满足再障妇女的需要，特别是考虑到#年的社会决定因素 美国产科医师学会建议的健康(SDH)和产后‘第四个三个月’阶段 和妇科医生(ACOG)。患者导航(PN)在改善护理一致性方面已显示出有效性 以及在AA女性中解决SDH问题。然而，传统的PN模式在经济上难以规模化 并保持，这表明需要进行PN范式转变-将面对面的需求降至最低 导航员将更多的注意力放在临床和系统级别的护理改进上，将本地和 联邦计划支持解决SDH问题。在我们十年来在妇女保健和护理方面的PN工作的基础上 协调清单，我们建议开发一种学习的医疗保健提供方法，以PN为中心 一份优化、综合、全面的围产期护理清单。优化与ACOG高度一致 认可加强护理和团队合作过程的核对表。通过混合第1类群集 随机有效性-实施试验，我们将比较优化干预的有效性 相对于标准护理，改善患者接受综合和全面围产期护理(产前 内容、产后内容和SDH内容)，同时评估 干预措施的实施。N=600名怀孕第一或第二个月的AA妇女将从20名妇女中招募 附属于两个社区卫生中心网络的诊所，为再生障碍性贫血提供大部分围产期护理 芝加哥的女人。诊所将按1：1随机分为标准护理(对照)或标准护理加优化 从第一次产前检查开始到产后12周进行PN支持(干预)的检查表。 优化清单将通过促进努力的协调和整合来扩大导航员的覆盖范围 跨围产期护理领域，并将SDH定向整合到围产期护理中。核对表，是根据 每个诊所内的工作流程将包含每个患者的产前、产后和SDH内容。初级阶段 结果是患者接受了由医疗记录收集的这三个内容领域的围产期护理组成部分 复习一下。次要结果包括抑郁症状、母乳喂养、疫苗(Tdap、流感、HPV)和 避孕药使用。实施研究综合框架将指导我们的混合方法 评估干预措施实施情况并确定实施促进者和障碍的方法。

Persistent and worsening racial and ethnic disparities in maternal and infant outcomes in the US are urgent public health concerns. African American (AA) women have about twice the risk of preterm birth and low birthweight compared with non-Hispanic white women and are more likely to suffer from complications of pregnancy and severe maternal morbidity. As these disparities worsen, there has been renewed focus on perinatal care. The perinatal period, those weeks before and after birth, has important implications for a woman's health and that of her child. Unfortunately, the prevailing perinatal standard care model has been stagnant for decades and is not meeting the needs of AA women, especially with consideration to Social Determinants of Health (SDH) and the `fourth trimester' postpartum period proposed by the American College of Obstetricians and Gynecologists (ACOG). Patient navigation (PN) has demonstrated efficacy in improving consistency of care and addressing SDH among AA women. However, traditional PN models are economically challenging to scale and sustain, suggesting that a PN paradigm shift is needed – one that minimizes the need for in-person navigators and places greater focus on clinic and systems level care improvement that integrates local and federally program support addressing SDH. Building on our decade of work in PN in women's health and care coordination checklists, we propose to develop a learning health care delivery approach to PN centered around an OPTIMIZE integrated and comprehensive perinatal care checklist. OPTIMIZE is highly aligned with ACOG endorsement of checklists for enhancing processes of care and teamwork. Through a Hybrid type 1 cluster randomized effectiveness-implementation trial, we will compare the effectiveness of the OPTIMIZE intervention relative to standard care in improving patient receipt of integrated and comprehensive perinatal care (prenatal content, postpartum content, and SDH content) tailored to a woman's individual needs, while evaluating intervention implementation. N=600 AA women in their 1st or 2nd trimester of pregnancy will be recruited from 20 clinics affiliated with two community health center networks that provide the majority of perinatal care for AA women in Chicago. Clinics will be randomized 1:1 to standard care (control) or standard care plus OPTIMIZE checklist with PN support (intervention) starting from the initial prenatal visit and through 12-weeks postpartum. The OPTIMIZE checklist will scale the reach of navigators by facilitating coordination and integration of efforts across perinatal care domains and integrating a SDH orientation to perinatal care. The checklist, tailored to the workflow within each clinic, will contain prenatal, postpartum, and SDH content for each patient. The primary outcome is patient receipt of perinatal care components in these 3 content areas collected by medical records review. Secondary outcomes include depressive symptoms, breastfeeding, vaccine (Tdap, influenza, HPV) and contraception uptake. The Consolidated Framework for Implementation Research will guide our mixed-methods approach to evaluate intervention implementation and identify implementation facilitators and barriers.