1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion , CDC, Atlanta, Georgia .
2 Association of Schools and Programs of Public Health , Washington, District of Columbia.
J Womens Health (Larchmt). 2019 Mar;28(3):346-356. doi: 10.1089/jwh.2018.7083. Epub 2018 Nov 2.
In 2014, the Association of State and Territorial Health Officials (ASTHO) convened a multistate Immediate Postpartum Long-Acting Reversible Contraception (LARC) Learning Community to facilitate cross-state collaboration in implementation of policies. The Learning Community model was based on systems change, through multistate peer-to-peer learning and strategy-sharing activities. This study uses interview data from 13 participating state teams to identify state-implemented strategies within defined domains that support policy implementation.
Semistructured interviews were conducted by the ASTHO team with state team members participating in the Learning Community. Interviews were transcribed and implementation strategies were coded. Using qualitative analysis, the state-reported domains with the most strategies were identified.
The five leading domains included the following: stakeholder partnerships; provider training; outreach; payment streams/reimbursement; and data, monitoring and evaluation. Stakeholder partnership was identified as a cross-cutting domain. Every state team used strategies for stakeholder partnerships and provider training, 12 reported planning or engaging in outreach efforts, 11 addressed provider and facility reimbursement, and 10 implemented data evaluation strategies. All states leveraged partnerships to support information sharing, identify provider champions, and pilot immediate postpartum LARC programs in select delivery facilities.
Implementing immediate postpartum LARC policies in states involves leveraging partnerships to develop and implement strategies. Identifying champions, piloting programs, and collecting facility-level evaluation data are scalable activities that may strengthen state efforts to improve access to immediate postpartum LARC, a public health service for preventing short interbirth intervals and unintended pregnancy among postpartum women.
2014 年，州和地区卫生官员协会（ASTHO）召集了一个多州即刻产后长效可逆避孕（LARC）学习社区，以促进各州之间在政策实施方面的合作。学习社区模式基于系统的改变，通过多州同行间的学习和策略共享活动。本研究使用来自 13 个参与州团队的访谈数据，确定了在既定领域内支持政策实施的州实施策略。
ASTHO 团队对参与学习社区的州团队成员进行了半结构化访谈。对访谈进行了转录，并对实施策略进行了编码。使用定性分析，确定了报告策略最多的州域。
五个主要领域包括以下内容：利益相关者伙伴关系；提供者培训；外展；支付渠道/报销；以及数据、监测和评估。利益相关者伙伴关系被确定为一个跨领域的问题。每个州团队都使用了利益相关者伙伴关系和提供者培训的策略，12 个州报告了计划或参与外展工作，11 个州解决了提供者和医疗机构报销问题，10 个州实施了数据评估策略。所有州都利用伙伴关系支持信息共享、确定提供者的拥护者，并在选定的分娩机构试行即刻产后 LARC 项目。
在各州实施即刻产后 LARC 政策涉及利用伙伴关系制定和实施策略。确定拥护者、试行项目和收集机构层面的评估数据是可扩展的活动，这些活动可能会加强各州改善即刻产后 LARC 获得的努力，这是一项公共卫生服务，旨在预防产后妇女的短生育间隔和意外怀孕。
