System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy

影响妊娠期高血压疾病妇女产后向初级保健过渡以进行心血管疾病风险管理的系统因素

• 批准号: 10874022
• 负责人: Laura B Attanasio
• 金额: $ 66.56万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10874022
• 关键词: Address; Birth; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Chronic; Cigarette; Diagnostic; Dimensions; Discipline of obstetrics; Eclampsia; Enhancers; Face; Family history of; Funding; Future; Health; Health system; Healthcare; Heart failure; Hyperlipidemia; Hypertension; Insurance; Intervention; Interview; Knowledge; Life Cycle Stages; Managed Care; Massachusetts; Maternal Mortality; Metabolic syndrome; Methods; Myocardial Ischemia; National Heart, Lung, and Blood Institute; Patients; Pattern; Performance; Policies; Population; Postpartum Period; Postpartum Women; Pre-Eclampsia; Pregnancy; Preventive; Primary Care; Process; Qualifying; Quality of Care; Recommendation; Recording of previous events; Research; Research Personnel; Risk; Risk Assessment; Risk Management; Role; Sampling; Shapes; Site; Smoking; Stroke; Structure; System; United States; Woman; Work; adverse outcome; cardiometabolic risk; cardiovascular disorder risk; cardiovascular health; child bearing; clinical practice; contextual factors; critical period; design; experience; health care quality; health care service organization; health difference; high risk; hypertension treatment; improved; interest; maternal morbidity; medical specialties; perinatal women; pharmacologic; policy recommendation; postpartum care; pregnancy hypertension; primary care clinician; sex; women of color

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death among women in the United States. Women who experience hypertensive disorders in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia, face substantially higher future CVD risk. About one in seven women experience HDP by the end of their childbearing years, with higher rates among women of color. Transitioning to primary care postpartum is recommended for all women, but has particular urgency for women with HDP. Women with HDP have a high risk of adverse outcomes in the immediate postpartum period (e.g. maternal morbidity and mortality), one to three years postpartum (e.g., hypertension, metabolic syndrome onset), and long-term (e.g. ischemic heart disease, heart failure, stroke). The limited existing research on postpartum primary care utilization shows that up to 80% of women who experienced HDP do not receive primary care in the year following birth. Primary care is an appropriate setting for short and long-term CVD risk management, including identification and treatment of hypertension and hyperlipidemia. However, little is known about the primary care provided for postpartum women with HDP and whether it responds to their heightened CVD risk. Despite low rates of postpartum transition to primary care for women with HDP, little is known about how systems factors impact this transition and primary care CVD risk assessment and management in the postpartum year. Using an explanatory-sequential mixed methods design, we examine the postpartum transition to primary care for CVD risk management for women with HDP in Massachusetts and nationally. These aims address NHLBI’s strategic objective to “investigate factors that account for differences in health among populations,” which includes managing cardiometabolic risk to improve health trajectories in sex-specific populations. The specific aims are 1) To determine the role of systems factors in the transition to preventive primary care for women with HDP in the postpartum year; 2) To characterize and examine clinician and organizational factors influencing cardiometabolic risk assessment and management in primary care in the postpartum year; and 3) To identify organizational and contextual factors shaping the postpartum transition to primary care and CVD risk management in primary care. With input from a multi-stakeholder advisory board, we will integrate results across aims to develop practice and policy recommendations to improve care quality for women with HDP to reduce future CVD risk. Results from this study will contribute to an improved understanding of systems factors associated with successful transition to postpartum primary care for women at high CVD risk, and help to identify interventions, healthcare quality metrics, and policy levers to improve clinical practice.

项目摘要 心血管疾病（CVD）是美国妇女死亡的主要原因。女性 在怀孕（HDP）中患有高血压疾病的人，包括慢性高血压，妊娠 高血压和先兆子痫/eClampsia面临着更高的未来CVD风险。大约七分之一 妇女在生育年份结束时体验了HDP，有色女性的比率更高。 建议所有妇女过渡到产后过渡到初级保健，但对妇女特别紧迫 使用HDP。 HDP的妇女在产后立即发生不良后果的高风险（例如 产后一到三年的母体发病率和死亡率）（例如，高血压，代谢综合征 发作）和长期（例如缺血性心脏病，心力衰竭，中风）。现有的关于有限的研究 产后初级保健使用表明，多达80％的经历HDP的妇女没有接受 出生后一年的初级保健。初级保健是短期和长期CVD风险的合适设置 管理，包括高血压和高脂血症的鉴定和治疗。但是，几乎没有 知道为有HDP的产后妇女提供的初级保健以及是否对其做出反应 CVD风险增加。尽管对HDP女性的产后过渡到产后过渡率低，但很少 知道系统因素如何影响此过渡和初级保健CVD风险评估以及 产后的管理。使用爆炸性的序列混合方法设计，我们检查了 马萨诸塞州HDP妇女的CVD风险管理过渡到初级保健的产后过渡 全国。这些目的涉及NHLBI的战略目标，以“调查有关差异的因素 在人群中的健康中，“包括管理心脏代谢风险以改善健康轨迹 性别特定的人群。具体目的是1）确定系统因素在过渡到向 产后为患有HDP女性的预防性初级保健； 2）表征和检查临床 以及影响心脏代谢风险评估和初级保健中的组织因素 产后年； 3）确定组织和上下文因素塑造产后过渡到 初级保健中的初级保健风险管理。通过来自多方利益相关者顾问委员会的意见， 我们将整合跨越旨在开发实践和政策建议以提高护理质量的结果 对于患有HDP的妇女，可以降低未来的CVD风险。这项研究的结果将有助于改善 了解与成功过渡到产后初级保健相关的系统因素 高CVD风险，并有助于确定干预措施，医疗保健质量指标和政策杠杆以改进 临床实践。