Fourth Trimester-A Web-based Tool For Postpartum Care To Address The needs Of Underserved Women

项目总结/摘要 产后是一个关键时期，一半以上的产妇死亡发生在产后。黑色 妇女的孕产妇死亡率是白色妇女的3-4倍。在美国，四分之一的女性 没有及时的产后访视，接受医疗补助管理式护理的妇女的依从性甚至更低 布局我们的家长补助金（R43 MD 014923）是资助制定一个计划，教育和支持 为“第四个三个月”的母亲，解决影响产后质量的身体、文化和知识障碍 在乎COVID-19危机为这一弱势群体带来了新的健康和经济挑战。 由于COVID-19带来的无数挑战，以及它将改变产后护理的方式， 我们有责任修改我们的项目范围，以在我们的研究中解决COVID-19问题，并增加 我们正在建立的工具，以解决与这场危机有关的紧迫问题和需求。的 当前流行病的挑战将对少数民族和经济上处于危险之中的人群产生持久影响 由于基本的健康差距仍然存在，进一步限制了本已有限的及时和 适当的照顾。种族和少数民族妇女更有可能在医疗保险覆盖方面存在差距， 疫情期间及其后失业率上升使情况进一步复杂化， 经济危机此外，美国有超过3000万家小企业受到这场双重危机的严重打击- 其中许多是在医疗保健部门。它们对于向这一弱势群体提供服务至关重要 在经济不稳定时期，他们最有可能失去自己的业务。研究主要集中在 关注、需求和健康，并开发数字化工具，以缩小 专门解决COVID-19加剧的障碍的护理，对于保护 母亲和她们的孩子我们与社区团体和医疗保健提供者的密切关系，以及 国际扶轮卫生部、布朗大学、高盛10 KSB和社会企业的支持 温室效应，使我们能够立即开始扩大我们的范围，以了解更多关于COVID-19的影响 服务不足的妇女和支持她们的供应商社区。我们建议将我们的范围扩大到：· 开展定性研究活动，以获取有关COVID-19疫情和经济的具体信息 孕妇和最近产后妇女的危机，并对医疗保健支持人员进行采访 ·扩大原型的范围，以包括应对COVID-19危机的特定内容 对COVID-19相关需求的反馈;以及·系统地评估原型对关键 通过适度的试点研究衡量健康结果。我们将把复原力作为一项关键成果， 测量相关因素，如抑郁，焦虑，医疗保健利用和产后经历。 这些活动将为第二阶段的纵向数据收集提供一个基线; 产后护理计划;并为未来针对这一人群的干预措施和政策提供有价值的数据。

PROJECT SUMMARY/ABSTRACT The postpartum period is a critical time, and more than half of all maternal deaths occur postpartum. Black women are 3-4 times more likely than white women to experience maternal mortality. In the US, 1 in 4 women do not have a timely postpartum visit, and adherence is even lower for women on Medicaid managed care plans. Our Parent Grant (R43MD014923) was funded to develop a program that educates and supports mothers in the ‘fourth trimester’, to address the physical, cultural, and knowledge barriers to quality postpartum care. The COVID-19 crisis presents novel health and economic challenges for this vulnerable population. Because of the myriad challenges COVID-19 presents, and the ways in which it will transform postpartum care, it is our responsibility to revise the scope of our project to address COVID-19 in our research and to add features to the tool we are building to address immediate concerns and needs related to this crisis. The challenges of the current pandemic will have a lasting impact for minority and economically at-risk populations because fundamental health disparities persist, further inhibiting already limited access to timely and appropriate care. Racial and ethnic minority women are more likely to have gaps in health insurance coverage, a situation further complicated by the higher proportion of unemployment during the pandemic and ensuing economic crisis. In addition, there are over 30 million small businesses in the US hard hit by this dual crisis – many of which are in the healthcare sector. They are critical for providing services to this vulnerable population and are most at risk of losing their businesses during times of economic instability. Research focused on the concerns, needs, and health of underserved women, and the development of digital tools to reduce gaps in care which specifically address barriers exacerbated by COVID-19, are essential to protect the health of mothers and their babies. Our strong relationships with community groups and healthcare providers, and support of the RI Department of Health, Brown University, Goldman Sachs 10KSB, and Social Enterprise Greenhouse, enable us to immediately begin to broaden our scope to learn more about the COVID-19 impact on underserved women and the provider community that supports them. We propose to expand our scope to: • conduct qualitative research activities to obtain specific input regarding the COVID-19 pandemic and economic crisis from pregnant and recently postpartum women and conduct interviews with the healthcare support network during the COVID-19 crisis; • expand the scope of the prototype to include specific content responding to feedback on needs related to COVID-19; and • systematically assess the impact of the prototype on key health outcome measures through a modest pilot study. We will focus on resilience as a key outcome and will measure related factors such as depression, anxiety, healthcare utilization, and postpartum experiences. These activities will provide a baseline for longitudinal data collection in Phase II; result in an even stronger program for postpartum care; and provide valuable data for future interventions and policies for this population.