Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1..
Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1.
Womens Health Issues. 2021 May-Jun;31(3):204-218. doi: 10.1016/j.whi.2021.01.002. Epub 2021 Mar 8.
Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care.
We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility.
Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences.
The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
许多产妇在分娩后无法与现有的专科或初级保健联系，即使妊娠的临床和社会并发症表明她们有此需求。黑人和土著以及所有其他有色人种的妇女尤其受到护理碎片化和获得机会不均等的影响，再加上整个生命过程和医疗保健中种族主义的影响。
我们于 2018 年发起了“跨越生命历程妊娠和健康的鸿沟”倡议，召集患者、倡导者、提供者、研究人员、政策制定者和系统创新者，制定国家研究和行动计划。我们举行了为期两天的会议，融合了故事讲述、证据分析和共识建立，以确定与护理差距和不平等根源相关的关键主题。2019 年，70 多名利益相关者参加了六个工作组会议，根据公平、创新、有效性和可行性就战略重点达成共识。
工作组确定了跨越鸿沟的六个关键战略领域。这些领域包括：1）消除医疗保健机构内的体制和人际种族主义和偏见，将其作为医疗保健机构认证的要求；2）为社区组织提供基础设施支持；3）将整体的团队护理扩展到产后一年及以后，并在团队中纳入导乐和社区卫生工作者；4）扩大医疗补助覆盖范围和新的质量和绩效付费指标，将产妇护理和初级保健联系起来；5）建立系统以保存提供者之间的产妇叙述和数据；6）使研究与妇女的生活经历保持一致。
由此产生的议程为纠正妇女保健中的结构性鸿沟提出了前进的道路，倡导者、政策制定者、研究人员、医疗保健领导者、教育工作者和媒体都可以发挥关键作用。
