Integrated Clinic and Patient Technology-Enabled Program to Reduce the Risks of Cardiometabolic Disease Among Latinas with Prior Pregnancy Complications

摘要 近40%的拉丁裔经历不良妊娠结局（APO）， 发生心脏代谢疾病（CMD）的风险较高，包括2型糖尿病和/或心血管疾病 疾病初级保健环境已被确定为解决这一重大公共卫生问题的关键场所 由于初级保健提供者在分娩后6周内承担了大部分护理责任，因此需要提供更多的护理。虽然 目前，数字技术还没有被广泛使用，因此建议将其作为扩大访问的解决方案 在初级保健中提供这种预防服务。这种缺乏数字技术的可用性，为妇女与先前 在为大量拉丁裔人口服务的初级保健诊所中，APO是一个特别值得注意的差距， 拉丁美洲人在健康、覆盖面和获得医疗服务方面经历的许多历史性差距。据我们所 知识，拟议的SBIR将是有史以来第一次努力创建和测试一个综合诊所平台， 患者应用程序，使初级保健实践能够提供行为改变编程，以支持拉丁美洲人 五年后，他们的APO。综合系统将采用以用户为中心的设计方法开发 将提供该计划并提供社会服务的准专业人员的反馈纳入其中， 支持，和拉丁美洲患者，与成功营销计划的目标，初级保健诊所服务 拉丁裔该项目在其综合方法上具有创新性，解决了与之相关的5个主要APO问题。 未来的CMD是一个诊所平台，可以克服在初级保健中提供生活方式干预的关键障碍。 护理，依靠准专业人员提供计划，并结合个性化的方法， 为患者提供初级保健诊所的人口健康方法。具体目标是：目标1：建立诊所 平台，与我们现有的患者应用程序集成，以促进拉丁美洲人的健康行为， 目标2：开发和测试数字化工具和数字化培训工具包， 诊所平台，供准专业人员（如CHW，医疗助理，健康教育工作者）使用，并测试新的 现有患者应用程序中包含的功能;以及，目标3：评价 集成的诊所和患者应用程序。该团队包括一个多文化和多学科的小组， 临床医生和研究人员谁曾合作，为妇女在以前的技术为基础的干预措施， 产后几年Hola Bebé，Hola Salud解决了大量未满足的公共卫生需求， 为拉丁裔人口服务的初级保健诊所的商业潜力。我们的B2B方法是一致的 随着人口健康和初级保健中基于价值的支付的新趋势。

Abstract Nearly 40% of Latinas experience an adverse pregnancy outcome (APO) that places them at significantly higher risk of developing cardiometabolic disease (CMD), including type 2 diabetes and/ or cardiovascular disease. The primary care setting has been identified as a key locus for addressing this major public health need, as primary care providers assume responsibility for the majority of care 6 weeks after delivery. Although currently not widely available, digital technologies have been recommended as a solution for expanding access to such preventive services in primary care. This lack of availability of digital technologies for women with prior APOs is a particularly noteworthy gap among primary care clinics serving large Latina populations, given the many historical disparities experienced by Latinas in health, coverage, and access to care. To the best of our knowledge, the proposed SBIR would be the first-ever effort to create and test an integrated clinic platform and patient app to enable primary care practices to deliver behavior-change programming to support Latinas in the 5 years after their APO. The integrated system will be developed using a user centered design approach incorporating feedback from both paraprofessional staff who will deliver the program and provide social support, and Latina patients, with the goal of successfully marketing the program to primary care clinics serving Latinas. The project is innovative in its comprehensive approach that addresses the 5 major APOs associated with future CMD, a clinic platform that overcomes key barriers to delivering lifestyle interventions in primary care, reliance on paraprofessionals to deliver the program, and combining an individualized approach for patients with a population health approach for primary care clinics. Specific aims are: Aim 1: Develop a clinic platform to integrate with our existing patient application to promote healthy behaviors among Latinas with recent APOs predictive of CMD; Aim 2: Develop and test digital tools and digital training toolkit for the new clinic platform for use by paraprofessionals (e.g. CHWs, medical assistants, health educators) and test the new features incorporated in the existing patient app; and, Aim 3: Evaluate feasibility, usability, and acceptability of the integrated clinic and patient application. The team includes a multicultural and multidisciplinary group of clinicians and researchers who have collaborated on prior technology-based interventions for women in the postpartum years. Hola Bebé, Hola Salud addresses a large unmet public health need with significant commercial potential among primary care clinics serving Latina populations. Our B2B approach is consistent with emerging trends on population health and value-based payment in primary care.