The role of pediatric interconception care in preventing adverse birth outcomes

儿科避孕护理在预防不良分娩结局中的作用

• 批准号: 10249289
• 负责人: Emily F Gregory
• 金额: $ 16.66万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10249289
• 关键词: Academy; Address; Adult; Behavioral; Birth; Birth Intervals; Birth Rate; Care given by nurses; Caring; Child health care; Childhood; Clinical; Data; Enrollment; Ensure; Goals; Guidelines; Health; Health education; Health system; Healthcare; Healthcare Systems; High Risk Woman; Infant; Infant Mortality; Intervention; Interview; Maternal and Child Health; Medicaid; Medical; Medicine; Mental Health; Mentors; Methods; Modeling; Modification; Mothers; Motivation; National Institute of Child Health and Human Development; Obesity; Outcome; Pediatrics; Population; Postpartum Depression; Postpartum Women; Pragmatic clinical trial; Pregnancy; Pregnancy Outcome; Premature Birth; Preventive care; Preventive healthcare; Public Health; Qualitative Methods; Recommendation; Recording of previous events; Research; Research Personnel; Research Priority; Research Proposals; Risk; Risk Factors; Role; Services; Supervision; Techniques; Testing; Tobacco use; Training; United States; Weight; Woman; Women' s Health; Work; adverse birth outcomes; barrier to care; base; behavior change; behavioral health; care coordination; career; cost; disparity reduction; evidence base; experience; feasibility testing; health care delivery; health care service; health care service utilization; health care settings; health disparity; high risk; implementation science; improved; improved outcome; innovation; insight; maternal risk; modifiable behavior; modifiable risk; motivational enhancement therapy; novel strategies; nursing intervention; patient oriented; pediatrician; premature; prevent; primary outcome; programs; randomized trial; screening; secondary outcome; skills; training opportunity; treatment as usual

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.

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