Improving Health by Linking Postpartum and Well-Baby Visits

项目概要/摘要 在前一次分娩后18个月内怀孕（称为短妊娠间隔[IPI]） 母亲和婴儿处于包括先兆子痫、贫血和早产在内的不良健康结果的高风险中。 尽管有这些负面的健康后果，但近三分之一的妇女经历了短暂的IPI，这突出了 美国的重大公共卫生问题。 预防短期IPIs的一个关键方法是为产后（PP）妇女提供及时的 避孕。目前的标准临床实践是让妇女在分娩后六周返回， 产后访视，在此期间满足避孕需求。然而，许多妇女恢复性生活， 许多妇女，特别是低收入的少数民族妇女，不参加为期六周的PP活动， 这次访问。产后避孕率低使妇女容易意外怀孕 和严重的负面健康后果。因此，迫切需要采取替代办法， 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。 拟议的研究旨在：（1）制定一项全面的实施计划，将PP避孕与 通过社区卫生中心（CHC）共同安排访问的新生儿护理;（2）使用有效的- 实施混合设计，以评估这种连接孕产妇和新生儿的新系统级方法 由我们的合作伙伴组织AllianceChicago提供服务。最后，我们的目标是：（3）评估 实施与PP避孕和新生儿护理相关的措施，并报告相关的主要障碍和促进因素 成功实施干预措施。 增加获得及时避孕药具的机会是一项很有希望的战略，可以帮助妇女计划生育， 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的获得，减少PP妇女和婴儿的负面健康结果 避孕保健。研究结果可能提供证据支持相关PP护理的范式转变，并确定 重要的见解，以促进在全国各地的社区卫生中心成功实施这种护理模式。

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.