Hamm Rebecca F, Moniz Michelle H, Wahid Inaya, Breman Rachel Blankstein, Callaghan-Koru Jennifer A
Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Implement Sci Commun. 2023 Jul 21;4(1):83. doi: 10.1186/s43058-023-00461-z.
Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA.
This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures.
Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research.
Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.
美国的孕产妇健康结果远差于其他同等水平的国家。加强孕产妇护理方面的实施研究对于解决护理质量差距和不必要的差异至关重要。在美国孕产妇健康研究投资计划中，实施研究的重点尚未得到明确界定或充分体现。
这项描述性研究采用改良德尔菲法，通过两项基于网络的连续调查，征集并排列实施科学与孕产妇健康交叉领域的研究重点。通过搜索已发表文章和资助数据库，确定了一个具有相关主题知识的有目的且广泛的研究人员样本。调查涉及孕产妇健康的五个实施研究领域：（1）应优先推广实施的做法；（2）应优先停止实施的做法；（3）关于实施决定因素的研究问题；（4）关于实施策略的研究问题；（5）关于方法/测量的研究问题。
在160名符合条件的研究人员中，82名（51.2%）同意参与。参与者以女性为主（90%），白人占75%。60人完成了两项调查中的至少一项。参与者认为应优先推广实施的做法包括改善产后护理、围产期和产后情绪障碍筛查与管理，以及妊娠期高血压疾病的标准化管理。对于停止实施，若从孕产妇护理中去除或减少，被认为最具影响力的做法是对低风险患者进行剖宫产以及孕期常规停用所有精神科药物。参与者在方法学上的首要重点是提高实施科学框架和措施解决公平性问题的程度，以及制定让患者参与实施研究的方法。
通过基于网络的德尔菲法，我们确定了研究人员认为最有潜力改善美国孕产妇护理质量的实施研究重点。这项研究还证明了使用改良德尔菲法让研究人员参与确定临床领域内实施研究重点的可行性。
