Green Hannah M, Daiter Maya, Carmona-Barrera Viridiana, Diaz Laura, Williams Brittney, Davis Ka'Derricka, Feinglass Joe, Cavens Arjeme, Nizik Charlotte, Dolan Brigid M, Kominiarek Michelle A, Grobman William A, Yee Lynn M
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Womens Health Rep (New Rochelle). 2025 Jul 23;6(1):691-701. doi: 10.1177/26884844251362313. eCollection 2025.
Although the postpartum period is an opportunity to promote long-term well-being and health systems usage, system complexities limit patients' abilities to optimize their longitudinal health. Postpartum patient navigation, an intervention that assists individuals in navigating health systems, is a novel innovation that may mitigate barriers to longitudinal care.
Within a recently completed randomized controlled trial (RCT), we conducted a secondary analysis of interviews with two navigators and a subset ( = 15) of navigated participants to describe gaps in the health care system. Semi-structured interview guides were used to conduct 11 sets of interviews with postpartum navigators. In the RCT, navigators supported publicly insured individuals for 1 year postpartum. Interviews focused on relationships with patients and care teams and reflections on health systems gaps which challenged care. Interviews were transcribed and analyzed using grounded theory. A randomly selected subset of interviews with navigated participants was analyzed to triangulate navigator-identified gaps.
Navigators identified three major gaps in the care system for postpartum individuals: overall health system challenges, postpartum care challenges, and gaps in the transition to primary care. Health system challenges included fragmentation within the hospital system, fragmentation across distinct health care institutions, high task burden for patients, and lack of clear communication between patients and care teams. Postpartum care challenges included operational and logistical errors in care and the transient nature of obstetric care. Gaps in the transition to primary care included a lack of emphasis on the importance of primary care, lack of administrative support in the transition, and lack of communication between care teams.
Postpartum patient navigators elucidated health systems gaps that present challenges in maximizing the longitudinal well-being of birthing individuals. These results identify areas for systems improvements that could promote lifelong health.
尽管产后阶段是促进长期健康和医疗系统利用的契机，但系统的复杂性限制了患者优化其长期健康的能力。产后患者导航是一种帮助个体在医疗系统中导航的干预措施，是一项可能减少长期护理障碍的创新举措。
在最近完成的一项随机对照试验（RCT）中，我们对两名导航员以及一部分（n = 15）接受导航服务的参与者进行了访谈的二次分析，以描述医疗系统中的差距。使用半结构化访谈指南对产后导航员进行了11组访谈。在RCT中，导航员为公共保险覆盖的个体提供产后1年的支持。访谈重点关注与患者和护理团队的关系，以及对挑战护理的医疗系统差距的反思。访谈进行了转录，并采用扎根理论进行分析。对随机选择的一部分接受导航服务的参与者的访谈进行了分析，以验证导航员识别出的差距。
导航员识别出产后个体护理系统中的三个主要差距：整体医疗系统挑战、产后护理挑战以及向初级护理过渡中的差距。医疗系统挑战包括医院系统内的碎片化、不同医疗机构之间的碎片化、患者的高任务负担以及患者与护理团队之间缺乏清晰的沟通。产后护理挑战包括护理中的操作和后勤失误以及产科护理的短暂性。向初级护理过渡中的差距包括对初级护理重要性缺乏重视、过渡过程中缺乏行政支持以及护理团队之间缺乏沟通。
产后患者导航员阐明了医疗系统中的差距，这些差距在最大化分娩个体的长期健康方面带来了挑战。这些结果确定了可以促进终身健康的系统改进领域。
