Improving Health by Linking Postpartum and Well-Baby Visits

项目摘要/摘要 在前次分娩后18个月内受孕的妊娠(称为短孕间隔[IPI]) 母亲和婴儿健康状况不佳的风险很高，包括先兆子痫、贫血和早产。 尽管有这些负面的健康后果，近三分之一的女性经历了短暂的IPI，这突显了 美国的重大公共卫生问题。 预防短暂性感染的一个关键方法是为产后(PP)妇女提供及时获得 避孕。目前的标准临床做法是让妇女在分娩后六周内返回 产后访问，在此期间避孕需求得到解决。然而，许多女性会恢复性生活 六周前的PP活动，许多妇女，特别是低收入少数族裔妇女，没有出席六周 这次访问。产后避孕使用率低使妇女容易发生意外怀孕 以及严重的负面健康后果。因此，迫切需要有替代办法来解决 增加及时获得避孕药具的机会，以改善妇女和儿童的结局。 拟议的研究旨在：(1)制定一项全面的执行计划，将PP避孕与 通过共同安排社区卫生中心(CHC)的访问来护理新生儿，以及(2)使用有效性- 实施混合设计以评估将产妇和新生儿联系在一起的新的系统级方法 由我们的合作伙伴组织Alliance Chicago提供服务的CHCs的关怀。最后，我们致力于：(3)评估 PP避孕和新生儿护理挂钩的实施情况以及关键障碍和相关促进者的报告 为成功实施干预措施干杯。 增加及时避孕的机会是一个很有希望的战略，可以帮助妇女规划她们的家庭，反过来， 减少因IPI妊娠时间较短而带来的不良健康后遗症。这项研究的长期影响是 通过增加以患者为导向的PP的机会，减少PP妇女和婴儿的负面健康后果 避孕护理。研究结果可能会提供证据支持关联PP护理和识别的范式转变 促进这种护理模式在全国各地的社区卫生保健中心成功实施的重要见解。

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.