Supporting Transitions to Primary care among Under-resourced, Postpartum women: The STEP-UP

支持资源不足的产后妇女向初级保健过渡：STEP-UP

• 批准号: 10637553
• 负责人: Stacy C Bailey
• 金额: $ 206.12万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637553
• 关键词: Address; Adoption; Affect; Black race; Blood Pressure Monitors; Body Size; Caring; Chicago; Chronic; Chronic Disease; Clinical; Community Healthcare; Counseling; Data; Detection; Diagnostic tests; Discipline of obstetrics; Disease; Disease Management; Disease Progression; Early Diagnosis; Early treatment; Education; Educational Materials; Electronic Health Record; Ethnic Origin; Evaluation; Evidence based treatment; Gestational Diabetes; Glycosylated hemoglobin A; Guidelines; Health; Heterogeneity; High-Risk Pregnancy; Hispanic; Home; Hypertension; Individual; Intervention; Language; Life; Logistics; Low income; Maintenance; Maternal Health; Medical; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Outcome; Patients; Pilot Projects; Postpartum Period; Postpartum Women; Prediabetes syndrome; Pregnancy; Primary Health Care; Provider; Race; Resources; Risk; Schedule; Site; System; Technology; Telephone; Testing; Text Messaging; Touch sensation; Visit; Woman; Work; base; cardiometabolic risk; cardiometabolism; care providers; clinical decision support; cost; design; effectiveness testing; ethnic minority population; fasting glucose; follow-up; health care settings; health equity; health literacy; high risk; hypertension treatment; improved; intervention effect; mortality; novel; obstetric care; outreach; pregnancy disorder; racial minority; response; safety net; treatment as usual; Address; Adoption; Affect; Black race; Blood Pressure Monitors; Body Size; Caring; Chicago; Chronic; Chronic Disease; Clinical; Community Healthcare; Counseling; Data; Detection; Diagnostic tests; Discipline of obstetrics; Disease; Disease Management; Disease Progression; Early Diagnosis; Early treatment; Education; Educational Materials; Electronic Health Record; Ethnic Origin; Evaluation; Evidence based treatment; Gestational Diabetes; Glycosylated hemoglobin A; Guidelines; Health; Heterogeneity; High-Risk Pregnancy; Hispanic; Home; Hypertension; Individual; Intervention; Language; Life; Logistics; Low income; Maintenance; Maternal Health; Medical; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Outcome; Patients; Pilot Projects; Postpartum Period; Postpartum Women; Prediabetes syndrome; Pregnancy; Primary Health Care; Provider; Race; Resources; Risk; Schedule; Site; System; Technology; Telephone; Testing; Text Messaging; Touch sensation; Visit; Woman; Work; base; cardiometabolic risk; cardiometabolism; care providers; clinical decision support; cost; design; effectiveness testing; ethnic minority population; fasting glucose; follow-up; health care settings; health equity; health literacy; high risk; hypertension treatment; improved; intervention effect; mortality; novel; obstetric care; outreach; pregnancy disorder; racial minority; response; safety net; treatment as usual

ABSTRACT We will test the effectiveness and fidelity of a technology-enabled, ‘stepped care’ strategy to connect high-risk, postpartum patients to primary care within under-resourced community health care settings. Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) affect up to 8% and 14% of pregnancies annually in the U.S. While GDM and HDP often resolve post-pregnancy, women with these disorders remain at increased, long-term risk of adverse cardiometabolic outcomes. Clinical guidelines therefore recommend that postpartum individuals with prior GDM and/or HDP transition from OB to primary care for ongoing evaluation and/or treatment. Yet studies show only one third of women with GDM and about half of women with HDP see a primary care provider within 6 months postpartum. Of those with GDM, only 1 in 5 complete recommended dysglycemia testing. Limited patient understanding of cardiometabolic risks, poor coordination between OB and primary care, and logistical challenges have been identified as barriers. Women who are Black, Hispanic, and/or low-income, with less education and/or low health literacy, are less likely to receive follow-up care. As early detection and treatment of hypertension and dysglycemia reduces disease progression, complications, and mortality, poor transitions in care is an issue of maternal health equity. In response, we will implement and test our Supporting Transitions to Primary care among Under-resourced, Postpartum women (STEP-UP) strategy. STEP-UP leverages available technologies to support transitions within health centers, from postpartum obstetric to primary care. Specifically, clinical decision support (CDS) in the EHR will prompt provider counseling on the primary care transition; it will also enable providers to order referrals and recommended glycemic tests with a single click. Patients will receive language-concordant materials that reinforce counseling, along with text messages to motivate and remind them to schedule and attend a primary care visit. STEP-UP was designed to be a low cost and ‘low touch’ intervention, yet while a technology-based strategy may work for most patients, it will not work for all. A ‘stepped care’ approach that provides additional, individualized outreach for only those who need it may be necessary. Thus, a centralized outreach coordinator will provide additional, phone-based support for any patient who has not scheduled a primary care visit by 4 months postpartum. We will test STEP-UP vs. usual care in a stepped-wedge trial at 4 large safety-net health centers. Our aims are to: 1) Test the effectiveness of STEP-UP, compared to usual care, to improve: a) primary care visit completion among women with prior GDM and/or HDP, b) testing for dysglycemia among women with prior GDM, and c) detection of dysglycemia and hypertension cases among women with prior GDM and/or HDP. We will also: 2) Investigate the heterogeneity of STEP-UP intervention effects by patients’ race, ethnicity, and language; and 3) Assess the reach, adoption, implementation, maintenance and costs of STEP-UP components. If successful, STEP-UP can be readily disseminated to community health centers nationwide.

抽象的 我们将测试以技术支持的“阶梯护理”策略的有效性和忠诚度 在资源不足的社区保健环境中，高风险的产后患者获得初级保健。 妊娠糖尿病（GDM）和妊娠高血压疾病（HDP）影响高达8％和14％ 每年在美国的怀孕，而GDM和HDP经常解决怀孕后，妇女与这些 疾病仍然存在不良心脏代谢结果的长期风险。因此，临床准则 建议产后患有先前GDM和/或HDP从OB到初级保健的人 正在进行的评估和/或治疗。然而研究表明，只有三分之一的GDM女性和大约一半 HDP的妇女在产后6个月内参见初级保健提供者。在具有GDM的人中，只有1个 完成建议的血糖测试。患者对心脏代谢风险的理解有限，差 OB与初级保健之间的协调以及后勤挑战已被确定为障碍。女性 黑人，西班牙裔和/或低收入的人，受过较少的教育和/或健康素养较低 接受后续护理。随着高血压和血糖的早期检测和治疗减少疾病 进展，并发症和死亡率，护理中的过渡不佳是母亲健康公平的问题。 作为回应，我们将在资源不足的， 产后妇女（升级）策略。升级利用可用技术来支持内部的过渡 卫生中心，从产后产科到初级保健。具体而言，临床决策支持（CD） EHR将促使提供者咨询初级保健过渡；它还将使提供者能够订购推荐 并单击一次建议进行血糖测试。患者将收到语言符合材料 加强咨询以及短信以动机并提醒他们安排并参加主要 照顾。升级被设计为低成本和“低触摸”干预措施，但虽然是基于技术的 策略可能适用于大多数患者，它不会适合所有人。一种“阶梯护理”方法，可提供其他， 只有需要它的人的个性化宣传可能是必要的。那是集中的外展协调员 将为任何未安排4个初级保健访问的患者提供额外的基于电话的支持 产后月。我们将在4个大型安全网健康的阶梯式审判中测试升级与通常的护理 中心。我们的目的是：1）与通常的护理相比，测试加速的有效性，以改进：a）主要 在患有GDM和/或HDP的妇女中的护理访问完成 先前的GDM，c）患有先前GDM和/或HDP的女性中血糖症和高血压病例的检测。 我们还将：2）调查患者种族，种族和种族和 语言; 3）评估升级，采用，实施，维护和加速组件的成本。 如果成功的话，可以很容易地在全国范围内传播到社区卫生中心。