Patient navigation to improve outcomes among low-income women in the postpartum period

患者导航可改善低收入女性产后的结局

基本信息

批准号：
10668971
负责人：
Lynn M Yee
金额：
$ 65.57万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10668971
关键词：
American College of Obstetricians and Gynecologists Black race Breast Feeding Caring Chronic Clinic Clinical Communication Contraceptive methods Counseling Depression screen Development Diabetes Mellitus Effectiveness Emotional Ethnic Origin Evaluation Family Focus Groups Frequencies Funding Glucose tolerance test Health Health Services Health Status Healthcare Healthcare Systems Hispanic Individual Insurance Intervention Interview Investigation Life Low income Maintenance Maternal Age Measures Medicaid Medical Medical Care Team Medical Records Methods Minority Women Modeling Not Hispanic or Latino Outcome Participant Patient Outcomes Assessments Patients Perception Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women Premature Birth Prenatal care Prevention Preventive care Primary Care Primary Care Physician Process Professional Organizations Provider Psyche structure Race Randomized Recommendation Research Risk Self Efficacy Services Social Change Social support Socioeconomic Status Surveys Text Messaging Time United States United States Dept. of Health and Human Services Update Vaccination Visit Weight Woman Women&apos s Health access disparities clinical care cohort comorbidity disparity reduction efficacy testing ethnic disparity experience fourth trimester health care disparity health care service utilization health disparity health outcome disparity improved improved outcome mHealth motherhood patient navigation patient navigator patient oriented postpartum care postpartum health pregnancy health primary outcome programs racial disparity randomized trial satisfaction socioeconomic disparity treatment as usual uptake

项目摘要

PROJECT SUMMARY The postpartum period – often called the “fourth trimester” – is a time of rapid and intense change in the life of a woman and her family, and uptake of health care during this transition is critical to optimizing women's long-term health and the health of their subsequent pregnancies. The importance of postpartum care has been reinforced by professional organizations, yet postpartum care in the United States remains inadequate. Substantial racial/ethnic and socioeconomic disparities in health care uptake, quality, and outcomes exist. Improving health for all women requires the development of new, more comprehensive approaches to postpartum and interconception care. One potential model may be patient navigation, which is a barrier-focused, longitudinal, patient-centered intervention that offers support for a defined set of health services. This proposal summarizes a 5-year research plan to evaluate whether implementation of a postpartum patient navigation program improves health outcomes among low-income women. We previously developed a postpartum patient navigation program, called Navigating New Motherhood (NNM), which introduced a clinic-level intervention in which a patient navigator assumed postpartum supportive and logistical responsibilities for low-income women. In this observational investigation, navigation was associated with improvements in outcomes (retention in care, contraception uptake, vaccination, and depression screening) compared to those of a historical cohort. We now propose to test the efficacy of the updated NNM model – called “NNM2” – via a randomized trial. We will randomize 400 pregnant or postpartum women with publicly- funded prenatal care to NNM2 navigation versus usual care (1:1). Women randomized to navigation will be provided intensive, individualized, one-on-one navigation services through 12 weeks postpartum and, based on individual needs, ongoing, tapered navigation through one year postpartum. Participants will undergo surveys, interviews, and medical record review at 4-12 weeks and 1 year postpartum. Aim 1 will evaluate whether the navigation program improves clinical outcomes at 4-12 weeks postpartum as measured via a composite of health status that includes retention in care, receipt of recommended counseling (anticipatory guidance), receipt of desired contraception, postpartum depression screening and care, breastfeeding initiation and maintenance, and receipt of indicated preventive care. Aim 2 will evaluate whether NNM2 improves patient-reported outcomes using both qualitative and quantitative methods. Aim 3 will evaluate provider experiences via focus groups and surveys. Completion of this study will fill an evidence gap by demonstrating whether postpartum patient navigation is an effective mechanism to improve women's short- and long-term health, enhance health care utilization, and improve patient and provider satisfaction.

项目概要产后期——通常被称为“妊娠第四期”——是女性生活快速而剧烈变化的时期。妇女及其家人，在这一转变期间接受医疗保健对于优化妇女的长期健康至关重要产后护理的重要性得到了加强。尽管美国的产后护理仍然不足，但专业组织仍然在进行。在改善健康方面存在种族/民族和社会经济差异。对于所有女性来说，需要制定新的、更全面的产后和产后护理方法一种潜在的模式可能是患者导航，这是一种以屏障为中心的、纵向的、以患者为中心的干预措施，为一组明确的卫生服务提供支持。该提案总结了一项为期 5 年的研究计划，旨在评估产后是否实施患者导航计划可改善低收入女性的健康状况。开发了一个产后患者导航程序，称为“新母亲导航”(NNM)，该程序引入了临床层面的干预措施，其中患者导航员承担产后支持和后勤工作在这项观察性调查中，导航与低收入妇女的责任有关。改善结果（保留护理、避孕措施、疫苗接种和抑郁症筛查）我们现在建议测试更新后的 NNM 模型的有效性 - 称为“NNM2”——通过一项随机试验，我们将随机抽取 400 名孕妇或产后妇女，并公开- 资助 NNM2 导航与常规护理的产前护理将被随机分配至导航的妇女。在产后 12 周内提供密集、个性化、一对一的导航服务，并基于参与者将根据个人需求，在产后一年内进行持续的、逐渐减少的导航。产后 4-12 周和 1 年的访谈和病历审查。目标 1 将评估导航程序是否可以改善产后 4-12 周的临床结果：通过综合健康状况进行衡量，包括保留护理、接受建议的咨询（预期指导），收到所需的避孕措施，产后抑郁症筛查和护理，目标 2 将评估是否开始母乳喂养、维持母乳喂养以及接受指定的预防性护理。 NNM2 将使用定性和定量方法来评估患者报告的结果。通过焦点小组和调查提供者的经验的完成将填补证据空白。证明产后患者导航是否是改善女性短期和短期妊娠的有效机制长期健康，提高医疗保健利用率，提高患者和提供者的满意度。

项目成果

期刊论文数量（12）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Bridging the postpartum gap: best practices for training of obstetrical patient navigators.

DOI：
10.1016/j.ajog.2021.03.038
发表时间：
2021-08
期刊：
American journal of obstetrics and gynecology
影响因子：
9.8
作者：
Yee LM;Williams B;Green HM;Carmona-Barrera V;Diaz L;Davis K;Kominiarek MA;Feinglass J;Zera CA;Grobman WA
通讯作者：
Grobman WA

Housing instability and adverse perinatal outcomes: a systematic review.

DOI：
10.1016/j.ajogmf.2021.100477
发表时间：
2021-11
期刊：
American journal of obstetrics & gynecology MFM
影响因子：
6.3
作者：
通讯作者：

Antepartum hospital use and delivery outcomes in California.

DOI：
10.1016/j.ajogmf.2021.100461
发表时间：
2021-11
期刊：
American journal of obstetrics & gynecology MFM
影响因子：
6.3
作者：
通讯作者：

The Stress of Parenting in the Postpartum Period During the COVID-19 Pandemic.

DOI：
10.1089/whr.2022.0029
发表时间：
2022
期刊：
WOMENS HEALTH REPORTS
影响因子：
1.3
作者：
Davis, Ka'Derricka M.;Lu, Layna;Williams, Brittney;Roas-Gomez, Maria, V;Leziak, Karolina;Jackson, Jenise;Feinglass, Joe;Yee, Lynn M.
通讯作者：
Yee, Lynn M.

Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals.

DOI：
10.1089/whr.2021.0009
发表时间：
2021
期刊：
Women's health reports (New Rochelle, N.Y.)
影响因子：
0
作者：
Ruderman RS;Dahl EC;Williams BR;Davis K;Feinglass JM;Grobman WA;Kominiarek MA;Yee LM
通讯作者：
Yee LM