Computer Assisted Support for Underserved Pregnant Women

描述(申请人提供)：早产造成75%的新生儿死亡和儿童长期神经损伤的一半，以及所有与出生有关的短期和长期发病率的很大一部分。自1981年以来，早产率上升了27%。2001年，早产儿的比例上升到11.9%，这是至少20年来的最高水平，每年出生婴儿超过44万人。在三个最大的种族/民族群体中，早产率都有所上升。低出生体重儿的比率在医疗服务不足的人群和少数族裔人群中更高-即使考虑到准入和保险覆盖等问题。早产占所有婴儿医疗保健支出的30%，占儿童医疗支出的10%。及时筛查和管理可改变的风险可以降低早产风险，提高母婴生活质量。然而，提供有效的产前风险管理系统以满足医疗服务不足人群的独特需求是复杂的。该应用程序的目标是开发一种实用且易于交付的、基于证据的计算机辅助干预系统，以筛选和帮助医疗服务不足的孕妇及其医疗保健提供者(HCP)管理与早产风险增加相关的可改变的状况。(HCP将利用这一系统与这些患者一起就降低风险的变化向患者提供咨询，妇女可以在需要时进行参考。)在第一阶段，我们将为拉美裔和非裔美国人编制评估和干预材料(在文化和语言上合适)，完成计算机编程，并在常规产前护理诊所访问期间进行可接受性测试。20名非洲裔美国女性和20名西班牙裔女性将从门诊随机选择，完成一项即时和短期的可接受性测试。医生、助产士和医疗保健组织经理也将提供可接受性数据。如果第一阶段可接受性测试成功，PCC LP将提交第二阶段疗效试验申请，以进一步完善和测试该系统。

DESCRIPTION (provided by applicant): Preterm births are responsible for 75 percent of neonatal mortality and one-half of long-term neurological impairments in children as well as a substantial portion of all birth-related short- and long-term morbidity. The preterm birth rate has risen 27 percent since 1981. The percent of preterm infants increased to 11.9 percent for 2001, the highest level in at least two decades accounting for more than 440,000 births annually. Preterm rates rose for each of the three largest racial/ethnic groups. Rates of low birth weight babies are higher in medically underserved and minority populations-even when issues such as access and insurance coverage are accounted for. Preterm births account for 30 percent of all health care spending on infants and 10 percent of spending for children. Timely screening and management of modifiable risks can reduce preterm birth risks and improve maternal and child quality of life. However, providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. The goal of this application is to develop a practical and easily delivered, evidence-based, computer-assisted intervention system to screen and assist medically underserved pregnant woman and their healthcare providers (HCPs) in managing modifiable conditions associated with increased risks of preterm births. (The HCPs will utilize this system with these patients to counsel patients on risk reduction changes the woman can make and refer when needed.) During Phase I, we will develop assessment and intervention materials (culturally and linguistically appropriate) for both Hispanic and African-American populations, complete computer programming and conduct acceptability testing during a routine 1st or 2nd trimester) prenatal care clinic visit. 20 African- American women and 20 Hispanic women will be randomly selected from outpatient clinics to complete an immediate and a short-term acceptability test. Physicians, nurse midwives and healthcare organization managers will also provide acceptability data. If Phase I acceptability tests are successful, PHCC LP will submit an application for a Phase II efficacy trial to further refine and test this system.