Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action.

Published on Mar 8, 2021in Womens Health Issues
· DOI :10.1016/J.WHI.2021.01.002
Lois McCloskey15
Estimated H-index: 15
(BU: Boston University),
Judith Bernstein28
Estimated H-index: 28
(BU: Boston University)
+ 69 AuthorsChristina Lachance1
Estimated H-index: 1
Source
Abstract
Abstract Background Many pregnant people find no bridge to ongoing specialty or primary care after delivery, 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. Methods 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. Findings 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. Conclusions 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.
References89
Newest
#1Ellen W. Seely (Harvard University)H-Index: 62
#2Ann C. Celi (Harvard University)H-Index: 6
Last. Janet W. Rich-Edwards (Harvard University)H-Index: 103
view all 13 authors...
Background: Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. Methods: The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for ...
2 CitationsSource
How Structural Racism Works As a legacy of African enslavement, structural racism affects both population and individual health in three interrelated domains: redlining and racialized residential s...
19 CitationsSource
In the wake of George Floyd’s public execution, uprisings have ignited in cities throughout the United States The words “I can’t breathe” hang heavy in the air Black people cannot breathe because we are currently battling at least two public health emergencies
28 Citations
#1Suzanne G. Leveille (University of Massachusetts Boston)H-Index: 80
#2Patricia Fitzgerald (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 5
Last. Jan Walker (Harvard University)H-Index: 31
view all 13 authors...
BACKGROUND Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE We examined patients' views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicia...
5 CitationsSource
#1Elpida Vounzoulaki (Leicester General Hospital)H-Index: 2
#2Kamlesh Khunti (Leicester General Hospital)H-Index: 95
Last. Clare L. Gillies (NIHR: National Institute for Health Research)H-Index: 22
view all 6 authors...
Objective: To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls. Design: Systematic review and meta-analysis.Data Sources: Medline and Embase from January 2000 to December 2019, studies published in the English language and conducted on humans.Eligibility Criteria for Selecting Studies: Observational studies investigating progression to T2DM. Inclusion criteria: post-partum follow-up for at least 12 mo...
42 CitationsSource
#1Annie SchmidtH-Index: 8
#2Samhita M. IlangoH-Index: 2
Last. Patience H. WhiteH-Index: 22
view all 5 authors...
Abstract Problem A previous systematic review found that health care transition (HCT) interventions result in positive outcomes related to population health, patient experience of care, and utilization. Since its publication, new national statistics, updated professional guidance, and a growing body of published literature on HCT have prompted the need for an updated systematic review that aims to examine outcomes of the latest pediatric-to-adult HCT interventions. Eligibility criteria Eligible ...
19 CitationsSource
1 CitationsSource
#1Sarah H. Gordon (BU: Boston University)H-Index: 7
#2Benjamin D. Sommers (Harvard University)H-Index: 50
Last. Amal N. Trivedi (Brown University)H-Index: 27
view all 4 authors...
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Medicaid enrollees are at higher risk of p...
14 CitationsSource
#1Melissa E. Cyr (NU: Northeastern University)H-Index: 1
#2Anna G. Etchin (VA Boston Healthcare System)H-Index: 1
Last. James C. Benneyan (NU: Northeastern University)H-Index: 22
view all 4 authors...
Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. ...
10 CitationsSource
#1Lois McCloskey (BU: Boston University)H-Index: 15
#2Emily Quinn (BU: Boston University)H-Index: 20
Last. Judith Bernstein (BU: Boston University)H-Index: 6
view all 9 authors...
Abstract Objective Our objective was to describe patient-, provider-, and health systems-level factors associated with likelihood of obtaining guideline-recommended follow-up to prevent or mitigate early-onset type 2 diabetes after a birth complicated by gestational diabetes (GDM). Methods This study presents a retrospective cohort analysis of de-identified demographic and health care system characteristics, and clinical claims data for 12,622 women with GDM who were continuously enrolled in a l...
4 CitationsSource
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#1Lois McCloskey (BU: Boston University)H-Index: 15
#2Judith Bernstein (BU: Boston University)H-Index: 28
Last. Chloe E. BirdH-Index: 37
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