Developing Autonomy-Centered models of 4th Trimester and Interconception care: Project 3

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Abstract

The United States (US) has the worst maternal outcomes of high-income countries, with poor outcomes, including death, disproportionately experienced by members of at-risk communities. The disproportionate risk for severe maternal morbidity (SMM) and maternal mortality (MM) is particularly stark in Pittsburgh and surrounding Allegheny County, where members of at-risk communities are more likely to die from pregnancy-related causes than in 97% of comparable cities. Notably, 80% of maternal deaths can be prevented, and 65% of maternal deaths occur in the postpartum period, which underscores why postpartum care is critical to reduce maternal mortality. Current models of postpartum care are limited by: 1) gaps in health care delivery at the very timepoints at which people are vulnerable to pregnancy-related death; 2) health care delivery frameworks that are not adapted to the needs of those most at risk and that have not been developed with community feedback; and/or 3) logistical barriers associated with acute financial stressors. If thoughtfully delivered, postpartum care may identify physical signs and symptoms of potential pregnancy-related morbidity and mortality. In this project, we seek to develop a novel model of postpartum care to reduce SMM and MM among those most at risk in our region. We will build upon an existing model of maternal health screening that is carried out at well-child visits and further integrate a recent model of postpartum care that has been adopted at several local health care sites, Fourth Trimester Care (4TM). 4TM expands postpartum care beyond the traditional one-time checkup with a clinician at six weeks post-delivery that had been the US standard of care. It moves the first postpartum visit to two weeks after delivery and includes maternal health examinations and anthropomorphic measures. This is a mixed-methods intervention research study which will use quantitative data from electronic health records to evaluate the current care models. This research also will use focus group discussions and in- depth interviews to collect qualitative data from patients who receive care in the current postpartum care model as well as from clinicians and staff to identify barriers and facilitators to postpartum care. Our team will engage with partners from the Community and Training Cores of the EMBRACE Center to develop and implement a community-informed model of postpartum care. Finally, we will deploy the new model of postpartum care over a multi-year period, to assess patient satisfaction, and clinical and implementation outcomes. We will pilot a novel intervention among a subset of these patients, responding to prior research that suggests that financial constraints not only contribute to acute stress in the postpartum period, but also undermine engagement with postpartum healthcare. Our objective is for our new model of postpartum care to be scalable to other health settings, and for our development process to serve as a blueprint for other healthcare systems to develop clinical care models that improve health outcomes and well-being for those most at risk during and after pregnancy.