CARE PATH Community Health Worker (CHW) Assessment for Postpartum Health

The United States (U.S.) has a higher maternal mortality ratio than most other high-income nations. Severe maternal mortality (SMM) and maternal mortality rates are elevated in rural counties compared to national averages. Births covered by Medicaid, of which there is a higher percentage in southern states (and Arkansas specifically), are more likely to experience postpartum SMM and maternal mortality. Individuals in rural, resource-limited counties are more likely to experience SMM and maternal mortality. Arkansas, the location for this study, is largely rural (41% of Arkansans vs 14% U.S.), has higher poverty rates (16.3% in Arkansas vs 11.5% U.S.), has more births covered by Medicaid (54% in Arkansas vs 42% U.S.), and is ranked second worst for the health of women and children among U.S. states. The maternal mortality ratio for Arkansas from 2018-2021 (the most recent data) was 43.5 deaths per 100,000 live births, nearly double the national ratio of 23.5 for the same time period. An estimated 75% of SMM and 76% of postpartum deaths occur within 6 weeks of delivery, with the vast majority (68%) within the first 3 weeks. Multiple studies demonstrate that the majority of postpartum ED visits could be addressed through outpatient care. The standard for postpartum care is a comprehensive visit scheduled approximately 6 weeks postpartum. Given that most postpartum SMM and maternal mortality happens before 6 weeks, one or more early postpartum visit(s) in the first 3 weeks is recommended as part of the American College of Obstetricians and Gynecologists’ (ACOG) 2018 guidelines. However, this early check-in has not been widely implemented. CARE PATH includes three weekly telehealth visits from a perinatal CHW to ensure timely identification and treatment of complications following ACOG guidelines; it is a fully powered RCT conducted among 500 rural postpartum individuals from a range of geographic and economic backgrounds, designed to compare: A) CARE PATH and B) usual care on postpartum visit completion, early detection of postpartum complications, postpartum hospital readmission and ED visits, and reproductive life planning/contraceptive counseling. CARE PATH has potential to reduce SMM and maternal mortality because it is conducted among rural postpartum individuals who experience the most pressing maternal health access challenges and are less often reached by existing health system innovations. CARE PATH directly addresses gaps in current scientific knowledge identified by systematic reviews and is expected to inform policy and practice, while meeting the needs and preferences of individuals residing in areas with limited healthcare infrastructure in Arkansas.