Improving Health by Linking Postpartum and Well-Baby Visits

项目概要/摘要 上次分娩后 18 个月内怀孕（称为短妊娠间隔 [IPI]） 母亲和婴儿面临健康状况不佳的高风险，包括先兆子痫、贫血和早产。 尽管存在这些负面健康后果，但近三分之一的女性经历过短暂的 IPI，这凸显了 美国的重大公共卫生问题 预防短期 IPI 的一个关键方法是为产后 (PP) 妇女提供及时的服务 避孕。目前的标准临床实践是让女性在产后六周返回进行检查。 产后访视，此时避孕需求得到解决。然而，许多女性恢复性生活 PP 前六周的活动，许多妇女，特别是低收入少数族裔妇女，没有参加 PP 活动 这次访问。产后避孕采用率低使女性容易意外怀孕 以及严重的负面健康后果。因此，迫切需要寻找替代方法 增加及时获得 PP 避孕药具的机会，以改善妇女和儿童的结局。 拟议研究的目的是：(1) 制定一项全面的实施计划，将 PP 避孕和 通过共同安排社区卫生中心 (CHC) 的就诊来提供新生儿护理，并且 (2) 使用有效的方法 实施混合设计来评估这种连接孕产妇和新生儿的新颖的系统级方法 我们的合作伙伴组织 AllianceChicago 为 CHC 提供护理服务。最后，我们的目标是：（3）评估 实施 PP 避孕和新生儿护理挂钩，并报告相关的主要障碍和促进因素 以成功实施干预措施。 增加及时避孕的机会是一项很有前途的战略，可以帮助妇女规划家庭，进而 减少与短期 IPI 妊娠相关的不良健康后遗症。这项研究的长期影响是 通过增加以患者为导向的 PP 的获取机会，减少 PP 妇女和婴儿的负面健康结果 避孕护理。研究结果可能提供支持相关 PP 护理范式转变的证据，并确定 促进在全国社区卫生中心成功实施这种护理模式的重要见解。

PROJECT SUMMARY/ABSTRACT Pregnancies conceived within 18 months of a prior delivery (termed short inter-pregnancy interval [IPI]) place mothers and infants at high risk for poor health outcomes including pre-eclampsia, anemia, and preterm birth. Despite these negative health consequences, nearly one third of women experience a short IPI, highlighting a significant public health problem in the U.S. A critical approach to preventing short IPIs is to provide postpartum (PP) women with timely access to contraception. The current standard clinical practice is to have women return six weeks after delivery for a postpartum visit, at which time contraceptive needs are addressed. However, many women resume sexual activity prior to six weeks PP, and many women, particularly low-income minority women, do not present for this visit. Low rates of postpartum contraception uptake leave women vulnerable to an unplanned pregnancy and significant negative health consequences. Thus, there is an urgent need for alternative approaches to increase timely access to PP contraception to improve outcomes for women and children. The proposed study aims to: (1) develop a comprehensive implementation plan to link PP contraception and newborn care through co-scheduling visits in community health centers (CHC) and (2) use an effectiveness- implementation hybrid design to evaluate this novel system-level approach to linking maternal and newborn care at CHCs served by our partner organization, AllianceChicago. Lastly, we aim to: (3) assess implementation of linked PP contraception and newborn care and report on key barriers and facilitators related to successful implementation of the intervention. Increasing access to timely contraception is a promising strategy to help women plan their families and, in turn, reduce the poor health sequela associated with short IPI pregnancies. The long-term impact of this study is to reduce negative health outcomes among PP women and infants by increasing access to patient-oriented PP contraceptive care. Findings may provide evidence supporting a paradigm shift for linked PP care and identify important insights to facilitate successful implementation of this model of care in CHCs across the nation.