Improving Health Outcomes by Targeting Postpartum Patients with High Need

Notable gaps in maternal mortality persist in the United States (U.S). Low-income patients are more likely to have a pregnancy-related death due to limited access to high quality care and high rates of underlying health conditions. These populations are more likely to begin pregnancy with chronic health conditions such as hypertension or diabetes, experience a complication while pregnant, and to experience life-threatening morbidity during delivery. Less recognized is that heightened maternal health risks extend into the postpartum period, where nearly 65% of deaths occur up to a year postpartum. These issues are particularly acute in Philadelphia where the maternal death rate is higher than the national average, the several maternal morbidity (SMM) rate is rising, and the majority of maternal deaths occur postpartum. Further, Philadelphia is the poorest among the nation’s ten largest cities, and its high-need zip codes are more prone to experience a postpartum complication, seek care in the emergency department (ED) after delivery, and are at increased risk for postpartum readmission. We propose a mixed method study to better pinpoint patients most at risk for poor outcomes following delivery, the problems they experience, and adapt an evidence-based intervention that aims to ensure all communities – including high SMM/mortality risk – have access to high quality care. This goal aligns with federal priorities to reduce excess health care utilization and improve health outcomes. The aims of our research study, “Improving Health Outcomes by Targeting Postpartum Patients with High Need” are to: 1) Develop a risk a prediction model using clinical, sociodemographic, behavioral, and neighborhood factors to pinpoint high-need patients using ED visits and postpartum readmissions as a marker of SMM. 2) Use qualitative methods to adapt and intensify an evidence-based behavioral educational intervention aimed at improving quality of care to reduce postpartum SMM as measured by postpartum ED use and hospital readmission, 3) Conduct a pilot RCT utilizing the cohort identified by the risk prediction model in Aim 1 to assess feasibility, acceptability, and target effect size and potential efficacy of the refined intervention to reduce ED visits and postpartum readmissions, and 4) Evaluate the pilot study results and procedures to inform the refinement of the intervention and to prepare for a larger implementation trial of this intervention to ensure universal availability for all.