MyPath: A Patient-Centered Web-Based Intervention to Improve Reproductive Planning for Women Veterans

MyPath：以患者为中心的基于网络的干预措施，旨在改善女性退伍军人的生殖计划

基本信息

批准号：
10754882
负责人：
Lisa Susanne Callegari
金额：
--
依托单位：
VA PUGET SOUND HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-10-01 至 2024-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10754882
关键词：
Acceleration Address Adherence Age Appointment Behavior Centers for Disease Control and Prevention (U.S.)Chronic Clinic Clinic Visits Clinical Communication Conceptions Conflict (Psychology)Contraceptive Agents Contraceptive Usage Contraceptive methods Counseling Data Data Collection Decision Making Economics Ensure Evaluation Face Family Fertility Goals Guidelines Health Health Care Costs Health behavior Healthcare Hybrids Intervention Interview Knowledge Link Low Birth Weight Infant Measures Medical Mental Health Methodology Methods Online Systems Outcome Outcome Assessment Patients Personal Satisfaction Pilot Projects Pregnancy Pregnancy Outcome Premature Birth Primary Care Process Provider Qualitative Methods Randomized, Controlled Trials Recommendation Reporting Reproductive Behavior Reproductive Health Research Research Design Risk Self Efficacy Services Site Social Well-Being Surveys Technology Telephone Testing Translational Research Veterans Visit Woman Women&apos s Health Women&apos s Health Services Workload adverse outcome aged automated text message child bearing cluster trial comorbidity comparison control cost design effective intervention effectiveness evaluation empowerment evidence base follow-up future implementation implementation barriers implementation facilitators implementation process improved indexing innovation intervention cost maternal depression maternal outcome neonatal outcome novel patient oriented patient-clinician communication physical conditioning pilot test pragmatic randomized trial preference primary care practice primary care provider primary care setting primary care visit primary outcome process evaluation programs reproductive research to practice risk mitigation secondary outcome shared decision making support tools tool treatment as usual unintended pregnancy urgent care provider web-based intervention whole health

项目摘要

Background: High rates of medical and mental health comorbidities result in elevated risks of poor maternal and neonatal outcomes among women Veterans compared to their civilian counterparts. Proactive planning and optimization of physical and mental health prior to pregnancy can mitigate these risks; however, nearly 40% of pregnancies among Veterans are unintended. National guidelines recommend routine delivery of patient-centered reproductive planning services in primary care, including assessment of reproductive goals followed by tailored contraceptive and/or preconception counseling, to reduce unintended pregnancy and improve pregnancy outcomes. Only 38% of women Veterans at risk of pregnancy, however, report having contraceptive or preconception health discussions with their primary care provider in the past year. We developed “MyPath,” a novel patient-facing web-based decision support tool, to address gaps in reproductive planning services in VA primary care. MyPath’s objectives are to help women Veterans consider their reproductive goals, increase their knowledge, align contraceptive and pregnancy timing decisions with their goals and health needs, and engage in shared decision making with providers. In pilot testing among 58 Veterans, use of MyPath prior to clinic visits was highly acceptable to Veterans and increased reproductive planning discussions compared to usual care without increasing providers’ perceived workload. MyPath use was also associated with increased decision quality and effective contraceptive use. Additional evaluation of MyPath in a pragmatic randomized trial is needed to assess effectiveness and collect implementation data. Significance/Impact: Patient-centered, scalable interventions that can enhance delivery of VA reproductive planning services without creating burden on primary care providers are urgently needed. The MyPath intervention leverages interactive patient-facing technology to empower women to make high-quality informed decisions and engage with providers about their reproductive health needs. If found to be successful, MyPath will lead to increased access to patient-centered reproductive planning services in VA primary care, addressing key HSR&D priorities, including access, primary care practice, women’s health, and whole health. Innovation: MyPath is the first online decision support tool designed to promote patient-centered reproductive planning services in primary care settings and to facilitate high-quality decisions aligned with reproductive goals. We will deliver the tool using the innovative strategy of partnering with the national VEText program to send the MyPath link to Veterans before appointments in an automated text message appointment reminder. Specific Aims: 1) Aim 1 will test the effect of the MyPath tool used before primary care visits on occurrence of reproductive planning discussions with shared decision making (primary outcome), patient-provider communication self-efficacy, and contraceptive decision quality, compared to usual care; 2) Aim 2 will test the longer-term effect of MyPath on contraceptive utilization, unintended pregnancy, and preconception health behaviors, compared to usual care; 3) Aim 3 is an implementation process evaluation, including quantitative and qualitative data collection to identify implementation barriers and facilitators and intervention costs. Methodology: This study is a 3-site hybrid type 1 pragmatic randomized controlled trial clustered at the provider level among 24 women’s health primary care providers and their reproductive-aged Veteran patients. We will assess outcomes among a minimum of 342 women Veterans by telephone surveys post-visit and at 3- and 6-month follow up. We will collect information on barriers and facilitators to implementation using quantitative and qualitative methods, including interviews with Veterans, providers, and clinic leaders. Next Steps/Implementation: The pragmatic design, in combination with strong operational partnerships, will enable rapid translation of research findings into practice if MyPath is found to be effective, with the ultimate objective of improving reproductive health outcomes and well-being among women Veterans nationally.

背景：医疗和心理健康合并症的高发生率导致贫困孕产妇的风险升高与平民相比，女性退伍军人的新生儿结局。然而，怀孕前优化身心健康几乎可以减轻这些风险；退伍军人中 40% 的怀孕是意外怀孕。国家指南建议常规分娩。初级保健中以患者为中心的生殖计划服务，包括生殖目标评估随后进行量身定制的避孕和/或孕前咨询，以减少意外怀孕和然而，只有 38% 的女性退伍军人报告有怀孕风险。去年与初级保健提供者进行过避孕或孕前健康讨论。开发了“MyPath”，一种面向患者的新型网络决策支持工具，旨在解决生殖方面的差距退伍军人事务部初级保健规划服务 MyPath 的目标是帮助女性退伍军人考虑她们的情况。生殖目标，增加他们的知识，根据他们的情况调整避孕和怀孕时间决定目标和健康需求，并在 58 家试点测试中与提供者共同决策。退伍军人，在诊所就诊之前使用 MyPath 是退伍军人高度接受的，并且可以提高生殖能力与常规护理相比，规划讨论不会增加提供商的 MyPath 使用工作量。还与决策质量的提高和避孕药具的有效使用相关。需要进行实用的随机试验中的 MyPath 来评估有效性并收集实施数据。意义/影响：以患者为中心、可扩展的干预措施，可增强 VA 生殖能力的实现迫切需要在不给初级保健提供者造成负担的情况下提供规划服务。干预措施利用面向患者的交互式技术，使女性能够获得高质量的信息如果发现成功，MyPath 会做出决定并与提供者就其生殖健康需求进行互动。将导致退伍军人事务部初级保健中获得更多以患者为中心的生殖计划服务的机会，解决 HSR&D 的关键优先事项，包括获取、初级保健实践、妇女健康和整体健康。创新：MyPath 是第一个旨在促进以患者为中心的生殖的在线决策支持工具规划初级保健机构的服务并促进与生殖相关的高质量决策我们将利用与国家 VEText 计划合作的创新战略来提供该工具，以实现在预约之前通过自动短信预约提醒将 MyPath 链接发送给退伍军人。具体目标： 1) 目标 1 将测试初级保健就诊前使用的 MyPath 工具对发生以下情况的效果：生殖计划讨论与共同决策（主要结果）、患者-提供者与常规护理相比，沟通自我效能和避孕决策质量；2) 目标 2 将测试 MyPath 对避孕药具使用、意外怀孕和孕前健康的长期影响行为，与常规护理相比；3) 目标 3 是实施过程评估，包括定量定性数据收集，以确定实施障碍和促进因素以及干预成本。方法：本研究是一项 3 中心混合 1 型实用随机对照试验，集中在 24 名女性健康初级保健提供者及其育龄退伍军人患者的提供者水平。我们将通过访问后和访问后 3 日的电话调查来评估至少 342 名女性退伍军人的结果我们将收集有关实施的障碍和促进因素的信息。定量和定性方法，包括对退伍军人、提供者和诊所负责人的访谈。后续步骤/实施：务实的设计与强大的运营合作伙伴关系相结合，将如果发现 MyPath 有效，则可以将研究成果快速转化为实践，并最终实现改善全国女性退伍军人的生殖健康结果和福祉的目标。