The Center for Care Continuity After Pregnancy Tailoring Transition Interventions for Underserved and Minority Mothers (CONTINUUM): A PaTH to Maternal Health Equity

Among minority women 90% of pregnancy-related deaths between postpartum days 7-365 are preventable. Transition breakdowns in prenatal to postpartum fail minority women who face the greatest risk of pregnancy-related mortality (PRM) and severe maternal morbidity (SMM). Residence in underserved areas especially maternity care deserts exacerbates disparities. Service redesign informed by patient lived experience and community-based organization partnerships can innovate integrated transition care solutions addressing comprehensive needs of these women. Minority serving institutions (MSIs) which maintain close ties to underserved communities are well suited to lead postpartum transition redesign research addressing PRM and SMM disparities. The Center is predicated on resource and capacity investments to sustain participatory patient-centered outcomes research at participating MSIs.

Goals and objectives:

Goal 1: Equitably reduce PRM and SMM in maternity care deserts and underserved communities through postpartum transition. Goal 2: Establish the Center for Care Continuity After Pregnancy: Tailoring Transition Interventions for Underserved and Minority Mothers (CONTINUUM). CONTINUUM is comprised of MSIs Howard University and Union Institute and University in collaboration with Ohio State University leveraging the PCORnet PaTH clinical research network. Goal 3: Clinically translate research findings. Objective 1: Plan and implement research studies addressing disparities in prenatal-to-longitudinal postpartum care transitions within maternity care deserts in Washington D.C. and Ohio Appalachia. Objective 2: Demonstrate increased maternal health research capacity within MSIs via resource investments capacity building mentoring and development. Objective 3: Broadly disseminate research findings via publications presentations and community-centered knowledge transfer. Objective 4: Translate implementation strategies to clinical and community settings. METHODS: CONTINUUM will advance an MSI patient-centered maternal health equity research model via 1) Stakeholder-guided evidence synthesis/ application of real-world health data using machine learning and patient journey mapping to develop best-worst scaling (BWS) experiments. 2) Perform BWS experiments to identify patient and clinician priorities. 3) Co-design prenatal-to-postpartum care transition model and implementation plan based on stakeholder priorities. 4) Implement postpartum transition model in maternity care deserts; evaluate model on patient-generated evaluation measures.

Products:

MSI stakeholder advisory council (engagement); PaTH CONTINUUM MSI scholars mentor and sponsor program (investigator pipeline/collaboration); MSI capacity for real-world data synthesis and implementation science (local research capacity); MSI-led publications and presentations (dissemination); toolkit for replicating the CONTINUUM model across PCORnet CRNs (scaling/ expansion); at least one MSI-led proposal to a non-HRSA federal agency (sustainability).

Evaluation:

We will: conduct annual assessment of CONTINUUM's MSI capacity across the organization human capacity partnerships culture and data dissemination and use via a modified Monitoring and Evaluation Capacity Assessment Toolkit; evaluate stakeholder engagement in using PCORnet Principles of Partnership; evaluate dissemination by number of publications and grant submissions; coordinate and align processes with the Coordinating Center