The role of pediatric interconception care in preventing adverse birth outcomes

摘要/摘要 早产发生在美国出生的10%，造成36%的婴儿死亡，每年花费260亿美元。重复 早产儿约占总早产儿的20%。预防保健，有效地解决 既往早产女性中的可改变风险（例如，烟草使用、体重状况、解释间隔） 出生可以合理地将整体早产率降低10%或更多。然而，我们的初步工作发现， 39%的医疗保险妇女在早产后一年没有得到预防性护理， 怀孕利用儿科卫生系统和新妈妈之间现有的联系，这项研究 提出了一种以儿科为基础的护士干预作为一种新的策略，以减少早产。我们假设 护理协调将增加预防性护理的接受。此外，我们建议嵌入 在护理协调模式中进行动机性访谈，以解决可改变的健康风险。我们 假设这种护理协调加上动机性访谈干预将增加 预防保健和减少可改变的行为风险，从而改善随后的生育结果。的 拟议的干预措施建立在现有的护理协调模式和先前证明可行性的工作基础上 母亲风险筛查在儿科的应用这种干预措施是对现有的受孕间（IC）护理的创新 模型包括：（1）将我们的干预措施定位在儿科医疗保健系统中，以利用现有的相互作用， (2)重点关注通过筛选确定的需求和风险应对战略，以及（3）实施 在护理协调中进行动机性面谈，以更好地应对可改变的风险。候选人，博士。 格雷戈里，进行了先前的母婴健康研究集中在IC期间。她的长期目标是 成为一名独立的母婴健康研究人员，开发临床项目，以改善生育 结果。这个为期五年的指导研究提案将通过课程工作支持她的目标， 完成指导研究。候选人培训将集中在三个目标：（1）激励 访谈，基于证据的行为改变策略，（2）实施科学，（3）务实 临床试验研究将针对两个具体目标。(Aim 1）将适应护理协调和激励 对有早产史的女性进行面试使用混合方法，从现有的 儿科护理协调，适应将侧重于有早产史的妇女的需求， 动机性访谈的整合。(Aim 1a：定性访谈;目标1b：迭代测试。）(Aim（2）意志 进行一项试验性的务实随机试验，比较常规护理与护理协调加动机性访谈， 既往有早产史的女性。本试验将证明干预的可行性并估计效应量 对卫生保健利用的干预。研究结果将为R 01水平试验提供信息，该试验将测试这种干预措施， 减少重复早产战略。该提案符合NICHD的研究重点，即改善 妇女在怀孕前、怀孕期间和怀孕后的健康，并改善怀孕结果。

Summary/Abstract Preterm births occur in 10% of US births, cause 36% of infant mortality, and cost $26 billion each year. Repeat preterm births represent approximately 20% of total prematurity. Preventive care that effectively addresses modifiable risks (e.g. tobacco use, weight status, interpregnancy interval) among women with a prior preterm birth could plausibly reduce overall preterm birth rates by 10% or more. However, our preliminary work found that 39% of Medicaid-insured women with a prior preterm birth received no preventive care in the year after pregnancy. Leveraging existing contact between pediatric health systems and new mothers, this research proposes a pediatric-based nurse intervention as a novel strategy to reduce prematurity. We hypothesize that nurse care coordination will increase receipt of preventive care. In addition, we propose embedding motivational interviewing within the care coordination model to address modifiable health risks. We hypothesize that this care coordination plus motivational interviewing intervention will increase receipt of preventive care and reduce modifiable behavioral risks, thus improving subsequent birth outcomes. The proposed intervention builds on existing care coordination models and on prior work demonstrating feasibility of maternal risk screening in pediatrics. This intervention innovates over existing interconception (IC) care models by: (1) locating our intervention in the pediatric health care system to capitalize on existing interactions, (2) focusing on strategies to address needs and risks identified through screening, and (3) implementing motivational interviewing within care coordination to better address modifiable risks. The candidate, Dr. Gregory, has conducted prior maternal-child health research focused on the IC period. Her long-term goal is to become an independent maternal-child health researcher developing clinical programs to improve birth outcomes. This five-year mentored research proposal will support her goal through course work and completion of mentored research. Candidate training will focus on three objectives: (1) motivational interviewing, an evidence-based behavior change strategy, (2) implementation science, and (3) pragmatic clinical trials. Research will address two specific aims. (Aim 1) will adapt care coordination and motivational interviewing for women with a prior preterm birth. Using mixed methods, and starting with existing models of pediatric care coordination, adaptation will focus on the needs of women with a history of preterm birth and on integration of motivational interviewing. (Aim 1a: qualitative interviews; Aim 1b: iterative testing.) (Aim 2) will conduct a pilot pragmatic randomized trial of usual care vs care coordination plus motivational interviewing for women with a prior preterm birth. This trial will demonstrate intervention feasibility and estimate the effect size of the intervention on health care utilization. Findings will inform an R01 level trial testing this intervention as a strategy to reduce repeat preterm birth. This proposal aligns with NICHD research priorities of improving the health of women before, during, and after pregnancy and improving pregnancy outcomes.