Identifying and Addressing Opportunities in Primary Care to Improve Healthy Birth Intervals

摘要 在美国，大约30%的怀孕发生在短暂的口译间隔(IPI)之后。 月份。短暂的IPI与不良的母婴结局有关，特别是在来自 高危人群。初级保健提供了接触和教育育龄患者的机会 关于生育间隔，在两次怀孕之间提供未孕和避孕护理(“间孕” 护理)，协调他们的急性和慢性护理需求。不良妊娠风险较高的人群 结果，如低收入妇女，更有可能从初级保健中获得生殖保健 服务提供者(PCP)而不是妇产科医生。美国四分之三的育龄妇女 各州每年至少有一次医生就诊，最常见的是与他们的初级保健医生一起就诊；然而，只有14%的办公室 探视涉及先入为主或避孕护理。许多PCP在交付时已经感到任务饱和 初级保健和在提供高质量的怀孕间保健方面面临许多障碍。尽管有些人 干预措施似乎是有效的，试图改善初级保健中的怀孕前/怀孕间护理 关爱，已经取得了有限的成功。我们推测，这可能是由于对可持续发展的设计不足。 实施到临床工作流程中。因此，这项发展研究将汇集关键的利益攸关方(例如 初级保健临床医生、护士、执业管理人员和工作人员)和三岁的女性育龄患者 参与故障模式、影响和危害性分析(FMECA)的各种主要实践。这一风险 评估工程方法将使我们能够充分描述和了解故障/遗漏 初级保健系统和流程中提供怀孕间护理的机会。然后我们会申请 以现有干预措施和FMECA结果为基础的以用户为中心的迭代设计方法， 创建一种新的干预措施，将有效的、以患者为中心的妊娠期保健整合到初级保健中。 在未来的工作中，我们打算使用II型混合实施/有效性试验来测试这种新的干预措施。

ABSTRACT Approximately 30% of pregnancies in the United States occur after a short interpregnancy interval (IPI) <18 months. Short IPI is associated with adverse maternal and infant outcomes, especially among women from high-risk populations. Primary care offers an opportunity to engage and educate reproductive age patients about birth spacing, provide preconception and contraceptive care between pregnancies (“interconception” care) and coordinate their acute and chronic care needs. Groups with higher risks of adverse pregnancy outcomes, such as low-income women, are more likely to receive their reproductive care from a primary care provider (PCP) than an obstetrician-gynecologist. Three quarters of reproductive age women in the United States have at least one physician visit each year, most commonly with their PCP; however, only 14% of office visits involve preconception or contraceptive care. Many PCPs already feel task-saturated when delivering primary care and face numerous barriers to providing high-quality interconception care. Although some interventions appear to be effective, attempts to improve preconception/interconception care, within primary care, have had limited success. We hypothesize that this may be due to inadequate design for sustainable implementation into clinical workflows. This developmental study will therefore gather key stakeholders (e.g. primary care clinicians, nurses, practice administrators and staff) and female reproductive age patients at three diverse primary practices to take part in a failure modes effects and criticality analysis (FMECA). This risk assessment engineering methodology will allow us to fully characterize and understand the failures/missed opportunities in the systems and processes of primary care to deliver interconception care. We will then apply an iterative user-centered design approach, building from existing interventions and from the FMECA results, to create a novel intervention for integrating effective, patient-centered interconception care into primary care. In future work, we intend to test this novel intervention using a type II hybrid implementation/effectiveness trial.