System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy

影响妊娠期高血压疾病妇女产后向初级保健过渡以进行心血管疾病风险管理的系统因素

• 批准号: 10874022
• 负责人: Laura B Attanasio
• 金额: $ 66.56万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10874022
• 关键词: Address; Birth; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Chronic; Cigarette; Diagnostic; Dimensions; Discipline of obstetrics; Eclampsia; Enhancers; Face; Family history of; Funding; Future; Health; Health system; Healthcare; Heart failure; Hyperlipidemia; Hypertension; Insurance; Intervention; Interview; Knowledge; Life Cycle Stages; Managed Care; Massachusetts; Maternal Mortality; Metabolic syndrome; Methods; Myocardial Ischemia; National Heart, Lung, and Blood Institute; Patients; Pattern; Performance; Policies; Population; Postpartum Period; Postpartum Women; Pre-Eclampsia; Pregnancy; Preventive; Primary Care; Process; Qualifying; Quality of Care; Recommendation; Recording of previous events; Research; Research Personnel; Risk; Risk Assessment; Risk Management; Role; Sampling; Shapes; Site; Smoking; Stroke; Structure; System; United States; Woman; Work; adverse outcome; cardiometabolic risk; cardiovascular disorder risk; cardiovascular health; child bearing; clinical practice; contextual factors; critical period; design; experience; health care quality; health care service organization; health difference; high risk; hypertension treatment; improved; interest; maternal morbidity; medical specialties; perinatal women; pharmacologic; policy recommendation; postpartum care; pregnancy hypertension; primary care clinician; sex; women of color

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death among women in the United States. Women who experience hypertensive disorders in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia, face substantially higher future CVD risk. About one in seven women experience HDP by the end of their childbearing years, with higher rates among women of color. Transitioning to primary care postpartum is recommended for all women, but has particular urgency for women with HDP. Women with HDP have a high risk of adverse outcomes in the immediate postpartum period (e.g. maternal morbidity and mortality), one to three years postpartum (e.g., hypertension, metabolic syndrome onset), and long-term (e.g. ischemic heart disease, heart failure, stroke). The limited existing research on postpartum primary care utilization shows that up to 80% of women who experienced HDP do not receive primary care in the year following birth. Primary care is an appropriate setting for short and long-term CVD risk management, including identification and treatment of hypertension and hyperlipidemia. However, little is known about the primary care provided for postpartum women with HDP and whether it responds to their heightened CVD risk. Despite low rates of postpartum transition to primary care for women with HDP, little is known about how systems factors impact this transition and primary care CVD risk assessment and management in the postpartum year. Using an explanatory-sequential mixed methods design, we examine the postpartum transition to primary care for CVD risk management for women with HDP in Massachusetts and nationally. These aims address NHLBI’s strategic objective to “investigate factors that account for differences in health among populations,” which includes managing cardiometabolic risk to improve health trajectories in sex-specific populations. The specific aims are 1) To determine the role of systems factors in the transition to preventive primary care for women with HDP in the postpartum year; 2) To characterize and examine clinician and organizational factors influencing cardiometabolic risk assessment and management in primary care in the postpartum year; and 3) To identify organizational and contextual factors shaping the postpartum transition to primary care and CVD risk management in primary care. With input from a multi-stakeholder advisory board, we will integrate results across aims to develop practice and policy recommendations to improve care quality for women with HDP to reduce future CVD risk. Results from this study will contribute to an improved understanding of systems factors associated with successful transition to postpartum primary care for women at high CVD risk, and help to identify interventions, healthcare quality metrics, and policy levers to improve clinical practice.

项目摘要 心血管疾病（CVD）是美国女性死亡的主要原因。妇女 妊娠期高血压疾病（HDP），包括慢性高血压、妊娠期高血压 高血压和先兆子痫/子痫，未来面临显著更高CVD风险。大约七分之一 女性在生育年龄结束时经历HDP，有色人种女性的发病率更高。 过渡到初级保健产后建议所有妇女，但有妇女特别紧迫 关于HDP患有HDP的女性在产后立即出现不良结局的风险很高（例如， 产妇发病率和死亡率），产后一至三年（例如，高血压、代谢综合征 发作）和长期（例如缺血性心脏病、心力衰竭、中风）。有限的现有研究 产后初级保健利用表明，高达80%的妇女谁经历了HDP没有得到 出生后一年的初级保健。初级保健是短期和长期CVD风险的适当设置 管理，包括高血压和高脂血症的识别和治疗。然而， 了解为产后HDP妇女提供的初级保健，以及它是否对她们的 心血管疾病风险增加。尽管患有HDP的妇女产后过渡到初级保健的比率很低， 了解系统因素如何影响这种转变和初级保健CVD风险评估， 产后一年的管理。使用序贯混合方法设计，我们检查了 马萨诸塞州HDP妇女产后过渡到初级保健以进行CVD风险管理， 全国范围内。这些目标涉及NHLBI的战略目标，即“调查造成差异的因素 其中包括管理心脏代谢风险，以改善健康轨迹， 性别特异性人群。具体目标是：（1）确定系统因素在过渡到 产后一年HDP妇女的预防性初级保健; 2）表征和检查临床医生 影响心脏代谢风险评估和管理的组织因素 产后一年;和3）确定组织和背景因素塑造产后过渡到 初级保健和初级保健中的CVD风险管理。在多方利益攸关方咨询委员会的投入下， 我们将整合各个目标的结果，制定实践和政策建议，以提高护理质量。 对于患有HDP的女性，以降低未来的CVD风险。这项研究的结果将有助于改善 了解与成功过渡到妇女产后初级保健相关的系统因素 高CVD风险，并帮助确定干预措施，医疗质量指标和政策杠杆，以改善 临床实践