Yee Lynn M, Martinez Noelle G, Nguyen Antoinette T, Hajjar Nadia, Chen Melissa J, Simon Melissa A
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and the Departments of Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Department of Obstetrics and Gynecology, Division of Family Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics and Gynecology, Division of Family Planning, University of California, Davis, Sacramento, California.
Obstet Gynecol. 2017 May;129(5):925-933. doi: 10.1097/AOG.0000000000001977.
To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately before the program's initiation and to assess whether other postpartum health behaviors improved during the intervention period.
This is a prospective observational study of women enrolled in a patient navigation program compared with women receiving care before the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistic responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood with those of women receiving care in the same clinic for 1 year immediately before Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included World Health Organization (WHO) Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses.
Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (n=218) enrolled; these women were compared with 256 women in the historical cohort. Most women in both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health service characteristics between groups, although women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver neonates admitted to the neonatal intensive care unit. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% compared with 70.3%, P<.001), a difference that persisted after adjustment for potential confounding factors (adjusted odds ratio [OR] 3.57, 95% confidence interval [CI] 2.11-6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (adjusted OR 1.56, 95% CI 1.02-2.38), postpartum depression screening (adjusted OR 2.82, 95% CI 1.79-4.43), and influenza (adjusted OR 2.10, 95% CI 1.38-3.19) and human papillomavirus vaccination (adjusted OR 2.33, 95% CI 1.25-4.33).
Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.
评估与在产后患者导航项目启动前立即接受护理的女性相比，参与产后患者导航项目的女性产后就诊率是否有所提高，并评估在干预期间其他产后健康行为是否得到改善。
这是一项前瞻性观察性研究，将参与患者导航项目的女性与项目开展前接受护理的女性进行比较。“引领新妈妈之路”是一项针对在以医疗补助为基础的大学诊所接受产前护理的成年英语女性的产后患者导航项目。2015年，“引领新妈妈之路”引入了一项诊所层面的变革，即雇佣一名导航员，在分娩至产后就诊结束期间为登记的患者承担支持和后勤职责。我们将“引领新妈妈之路”项目登记女性的病历数据与在“引领新妈妈之路”项目开展前1年在同一诊所接受护理的女性的病历数据进行了比较。主要结局是产后就诊率。次要结局包括世界卫生组织（WHO）一级或二级避孕措施的采用情况以及其他健康服务指标。我们进行了双变量和多变量分析。
在项目启动后邀请参与“引领新妈妈之路”项目的225名女性中，96.9%（n = 218）登记参与；这些女性与历史队列中的256名女性进行了比较。两组中的大多数女性都是少数族裔，且均有医疗补助保险。两组在人口统计学、临床或健康服务特征方面没有重要差异，尽管参与“引领新妈妈之路”项目的女性更有可能转入该诊所进行产前护理，并分娩入住新生儿重症监护病房的新生儿。主要结局，即产后护理复诊，在参与“引领新妈妈之路”项目的女性中更为常见（88.1% 对比70.3%，P <.001），在对潜在混杂因素进行调整后，这一差异仍然存在（调整后的优势比[OR] 3.57，95%置信区间[CI] 2.11 - 6.04）。参与“引领新妈妈之路”项目的女性也更有可能接受WHO一级或二级避孕方法（调整后的OR 1.56，95% CI 1.02 - 2.38）、产后抑郁症筛查（调整后的OR 2.82，95% CI 1.79 - 4.43）、流感疫苗接种（调整后的OR 2.10，95% CI 1.38 - 3.19）和人乳头瘤病毒疫苗接种（调整后的OR 2.33，95% CI 1.25 - 4.33）。
实施产后导航项目与常规产后护理的保留率提高以及避孕措施采用频率、抑郁症筛查和疫苗接种频率的提高相关。
