Integrated Clinic and Patient Technology-Enabled Program to Reduce the Risks of Cardiometabolic Disease Among Latinas with Prior Pregnancy Complications

摘要 近40%的拉丁裔经历了不良妊娠结局(APO)，这使他们显著 患心脏代谢性疾病(CMD)的风险较高，包括2型糖尿病和/或心血管疾病 疾病。初级保健环境已被确定为解决这一主要公共卫生问题的关键场所 需要，因为初级保健提供者在分娩后6周承担大部分护理的责任。虽然 目前还没有广泛可用的数字技术，已被推荐作为扩大访问的解决方案 在初级保健中提供这种预防性服务。对于有前科的女性来说，缺乏数字技术 APOS在服务于大量拉丁裔人口的初级保健诊所中是一个特别值得注意的差距，因为 拉丁裔在健康、覆盖面和获得保健方面经历了许多历史上的差距。尽我们最大努力 知识，拟议的SBIR将是有史以来第一次努力创建和测试综合临床平台和 患者应用程序使初级保健实践能够提供行为改变编程，以支持拉丁美洲人 在他们的APO 5年后。综合系统将采用以用户为中心的设计方法进行开发 纳入将提供该计划并提供社会服务的两个准专业人员的反馈 支持和拉丁裔患者，目标是成功地向提供服务的初级保健诊所推销该计划 拉丁裔。该项目在其综合方法方面具有创新性，涉及相关的5个主要APO 未来的CMD，一个克服初级生活方式干预关键障碍的临床平台 护理，依赖辅助专业人员提供计划，并结合个性化的方法 采用人口健康方法的患者提供初级保健诊所。具体目标是：目标1：发展诊所 与我们现有的患者应用程序集成的平台，以促进拉美裔美国人的健康行为 最近的APO预测CMD；目标2：开发和测试新的数字工具和数字培训工具包 诊所平台，供辅助专业人员(如社区卫生工作者、医疗助理、健康教育人员)使用，并测试新的 现有患者应用程序中包含的功能；目标3：评估可行性、可用性和可接受性 临床与患者一体化应用。该团队包括一个多文化和多学科的小组 临床医生和研究人员在先前对妇女进行基于技术的干预方面进行了合作 产后几年。Hola Bebé，Hola Salud解决了大量未得到满足的公共卫生需求 为拉美裔人口服务的初级保健诊所的商业潜力。我们的B2B方法是一致的 随着人口健康和初级保健中按价值付费的新趋势的出现。

Abstract Nearly 40% of Latinas experience an adverse pregnancy outcome (APO) that places them at significantly higher risk of developing cardiometabolic disease (CMD), including type 2 diabetes and/ or cardiovascular disease. The primary care setting has been identified as a key locus for addressing this major public health need, as primary care providers assume responsibility for the majority of care 6 weeks after delivery. Although currently not widely available, digital technologies have been recommended as a solution for expanding access to such preventive services in primary care. This lack of availability of digital technologies for women with prior APOs is a particularly noteworthy gap among primary care clinics serving large Latina populations, given the many historical disparities experienced by Latinas in health, coverage, and access to care. To the best of our knowledge, the proposed SBIR would be the first-ever effort to create and test an integrated clinic platform and patient app to enable primary care practices to deliver behavior-change programming to support Latinas in the 5 years after their APO. The integrated system will be developed using a user centered design approach incorporating feedback from both paraprofessional staff who will deliver the program and provide social support, and Latina patients, with the goal of successfully marketing the program to primary care clinics serving Latinas. The project is innovative in its comprehensive approach that addresses the 5 major APOs associated with future CMD, a clinic platform that overcomes key barriers to delivering lifestyle interventions in primary care, reliance on paraprofessionals to deliver the program, and combining an individualized approach for patients with a population health approach for primary care clinics. Specific aims are: Aim 1: Develop a clinic platform to integrate with our existing patient application to promote healthy behaviors among Latinas with recent APOs predictive of CMD; Aim 2: Develop and test digital tools and digital training toolkit for the new clinic platform for use by paraprofessionals (e.g. CHWs, medical assistants, health educators) and test the new features incorporated in the existing patient app; and, Aim 3: Evaluate feasibility, usability, and acceptability of the integrated clinic and patient application. The team includes a multicultural and multidisciplinary group of clinicians and researchers who have collaborated on prior technology-based interventions for women in the postpartum years. Hola Bebé, Hola Salud addresses a large unmet public health need with significant commercial potential among primary care clinics serving Latina populations. Our B2B approach is consistent with emerging trends on population health and value-based payment in primary care.