The Community Health Center - Reproductive Life Plan (CHC-RLP) Project

项目总结/摘要 背景：预防不良母婴结局的一项关键战略， 婴儿死亡率，是指在怀孕前后（怀孕前和怀孕期间）提供高质量的保健服务 护理）。在这些遭遇中，对患者怀孕愿望的探索允许提供患者- 基于这些目标的集中咨询和服务，以支持未来怀孕的健康， 防止意外发生。初级保健提供者（PCP），他们照顾大多数非孕妇， 生育年龄，是这一努力的重要伙伴，但研究表明，他们的可能性比产科 提供孕前或避孕保健的对口单位。结构性生殖健康 评估，被称为生殖生命计划（RLP），已被推广为一项战略， 将孕前护理纳入临床护理，其中一个工具，One Key Question®（OKQ）， 对于PCP，因为它允许进行有意义的，简短的评估，而无需成为生殖健康专家。 目标：社区卫生中心-生殖生命计划项目，由 AllianceChicago是一个由HRSA资助的健康中心控制的网络，具有共享的数据基础设施，包括 OKQ®作为一个结构化领域，将评估OKQ®实施对生殖健康指标的影响， 社区健康，初级保健，设置。在与朋友健康，在南区的CHC合作， 芝加哥，和一个研究小组，CHC-RLP项目将实现两个具体目标：1）进行一个 OKQ®实施的结构化培训，利用电子健康记录（EHR）作为工具;以及2） 利用EHR数据并利用实施科学框架来确定OKQ® 执行工作影响生殖健康（孕前和避孕保健）指标。 方法：本随机对照试验将以达到、有效性、采用、实施为指导 和维护（RE-AIM）框架。随机化将在初级保健提供者一级进行， 随机化的提供者将接受结构化的OKQ®培训，包括临床指导和支持 用于将OKQ®纳入临床工作流程和EHR中的文档。经过12个月的实施， 将探讨关于服务提供和结果的电子健康记录数据，以确定实施的成功与否， 在生殖健康结果（提供避孕药具和补充叶酸）方面， 接受干预组提供者护理的患者与 提供者在控制，日常护理，组。 预期结果的意义：这些结果将为未来的大规模疗效试验提供信息， 有可能领导医疗保险和医疗补助服务中心认可RLP作为质量指标，并进一步 确认保健信息技术作为减少保健差距的工具的概念。

PROJECT SUMMARY/ABSTRACT Background: A key strategy to the prevention of adverse maternal and child outcomes, like maternal and infant mortality, is the delivery of high-quality health care before and after pregnancy (pre and inter-conception care). In these encounters, the exploration of patients’ pregnancy desires allows for the provision of patient- centered counseling and services based on those goals to support the health of future pregnancies and prevent unintended ones. Primary Care Providers (PCPs), who care for most non-pregnant women of reproductive age, are essential partners in this effort, yet studies show they are less likely than their obstetric counterparts to provide preconception or contraceptive health care. Structured reproductive health assessments, known as reproductive life plans (RLP), have been promoted as a strategy to routinely integrate preconception care into clinical care, and one such tool, One Key Question® (OKQ), holds particular promise for PCPs, as it allows for a meaningful, brief, assessment without the need to be a reproductive health expert. Objectives: The Community Health Center-Reproductive Life Plan (CHC-RLP) Project, led by AllianceChicago, a HRSA funded Health Center-controlled network with a shared data infrastructure including OKQ® as a structured field, will assess the impact of OKQ® implementation on reproductive health metrics in the community health, primary care, setting. In partnership with Friend Health, a CHC in the South Side of Chicago, and a team of researchers, the CHC-RLP Project will achieve two specific aims: 1) conduct a structured training for OKQ® implementation, harnessing the electronic health record (EHR) as a tool; and 2) leverage EHR data and utilize an implementation science framework to determine whether OKQ® implementation influences reproductive health (preconception and contraceptive care) metrics. Methods: This randomized control trial will be guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance, (RE-AIM) framework. Randomization will occur at the level of the primary care provider, and randomized providers will receive structured OKQ® training, including both clinical guidance as well as support for incorporating OKQ® into clinic workflow and documentation in the EHR. After 12 months of implementation, EHR data on service provision and outcomes will be explored to determine success of the implementation and differences in reproductive health outcomes (contraceptive provision and folic acid supplementation) between the patients who received care from the providers in the intervention group as compared to patients from the providers in the control, usual-care, group. Implications of expected findings: The results will inform a future large-scale efficacy trial, which has the potential to lead the Centers for Medicare & Medicaid Services to endorse RLP as a quality metric, and further validate the notion of health information technology as a tool to mitigate health disparities.