The lack of postpartum primary care coordination is a missed opportunity to increase primary care engagement and manage chronic conditions early in life, especially for the \>30% of pregnant people who have or are at risk for these conditions. This study aims to increase postpartum primary care engagement, quality, and experience by strengthening postpartum transitions to primary care using a behavioral economics-informed, multi-component intervention integrated into usual inpatient postpartum care. Using a randomized controlled trial and repeated outcome assessments through administrative and survey data, this study will generate rigorous, actionable evidence to ensure primary care coordination becomes standard postpartum care practice, potentially catalyzing sustained primary care engagement throughout life.
Over 30% of pregnant people have at least one chronic medical condition, and 20% have certain prenatal conditions (e.g., pregnancy-related hypertension, gestational diabetes) that increase the risk of chronic disease later in life. While patients with these conditions are typically highly engaged in prenatal care, they encounter a "postpartum cliff" in health system support after delivery; many receive no postpartum primary care at all despite having ongoing medical needs. At a time of increased stress, sleep deprivation, and competing demands, they must navigate administrative burdens in accessing primary care, often without scheduling assistance or any formal handoff between their obstetric and primary care clinician (PCP). These burdens may lead to avoided or delayed postpartum primary care, exacerbating health inequities that existed prenatally even for those fortunate enough to have a PCP. Given the many benefits of primary care, this lack of obstetric-to-primary care coordination represents a missed opportunity to increase primary care engagement and manage chronic conditions earlier in life. The primary objective is to increase postpartum primary care engagement, quality, and experience by strengthening obstetric-to-primary care coordination using a behavioral economics-informed intervention. The intervention, integrated into routine inpatient postpartum care, includes default PCP visit scheduling, tailored nudge messages to patients, ongoing care recommendations sent to the PCP, and a summary of recommendations after pregnancy given to the patient. Using a robust randomized controlled trial of 1,320 participants that is built off of the team's pilot study, the proposed study will: (Aim 1) measure the intervention's impact on postpartum primary care visit completion, sustained engagement, and disparities in these outcomes; (Aim 2) measure the intervention's impact on high-value primary care service use; and (Aim 3) measure the intervention's impact on patient experience. The study will generate rigorous, actionable evidence to ensure primary care coordination becomes standard postpartum care practice and will provide insight into postpartum patients' health care experiences. By targeting a vulnerable population at a time of great need and opportunity, postpartum-to-primary care coordination has the potential to catalyze sustained primary care engagement throughout life and improve long-term health.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
TRIPLE
Enrollment
1,320
The intervention includes default PCP visit scheduling, tailored nudge messages to patients, ongoing care recommendations sent to the PCP, and a summary of recommendations after pregnancy given to the patient.
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGCompletion of a primary care visit
Observation of a visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).
Time frame: 155 days after date of delivery
Receipt of condition-specific recommended health screening and counseling by a primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as documented in the electronic health record. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) in the electronic health record. For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as documented in the electronic health record. "
Time frame: 155 days after date of delivery
Self-report of having a known, reliable primary care practitioner
The outcome is the Self-report of having a known, reliable primary care practitioner (doctor, nurse practitioner, or physician's assistant).
Time frame: 155 days after date of delivery
Self-report of mental health
Edinburgh Perinatal Depression Scale will be administered and the total EPDS score compared.
Time frame: 155 days after date of delivery
Completion of an annual exam with a primary care practitioner
Observation of an annual exam or health care maintenance visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).
Time frame: 155 days after date of delivery
Self-report of completion of a primary care visit
Self-report of a visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology) for any reason.
Time frame: 155 days after date of delivery
Self-report of an annual exam with a primary care practitioner
Self-report of an annual exam or health care maintenance visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).
Time frame: 155 days after date of delivery
Completion of a primary care visit
Observation of a visit with a primary care practitioner for any reason.
Time frame: 365 days after date of delivery
Self-report of completion of a primary care visit
Self-report of a visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology) for any reason.
Time frame: 365 days after date of delivery
Completion of an annual exam with a primary care practitioner
Observation of an annual exam or health care maintenance visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).
Time frame: 365 days after date of delivery
Self-report of an annual exam with a primary care practitioner
Self-report of an annual exam or health care maintenance visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).
Time frame: 365 days after date of delivery
Repeated primary care practitioner engagement
Observation of two or more primary care practitioner visits for any reason.
Time frame: 365 days after date of delivery
Self-report of repeated primary care practitioner engagement
Self-report of two or more primary care practitioner visits for any reason.
Time frame: 365 days after date of delivery
Extent of primary care practitioner engagement
Number of primary care practitioner visits for any reason.
Time frame: 365 days after date of delivery
Self-report of extent of primary care practitioner engagement
Self-report of the number of primary care practitioner visits for any reason.
Time frame: 365 days after date of delivery
Completion of a primary care visit
Observation of a visit with a primary care practitioner for any reason.
Time frame: 548 days after date of delivery
Completion of an annual exam with a primary care practitioner
Observation of an annual exam or health care maintenance visit with a primary care practitioner.
Time frame: 548 days after date of delivery
Repeated primary care practitioner engagement
Observation of two or more primary care practitioner visits for any reason.
Time frame: 548 days after date of delivery
Extent of primary care practitioner engagement
Number of primary care practitioner visits for any reason.
Time frame: 548 days after date of delivery
Self-report of receipt of condition-specific recommended health screening and counseling by a primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as reported by the participant. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) as reported by the participant. For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as reported by the participant.
Time frame: 155 days after date of delivery
Receipt of recommended screening and counseling for chronic condition by primary care practitioner
For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as documented in the electronic health record.
Time frame: 155 days after date of delivery
Receipt of recommended screening for gestational condition by primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as documented in the electronic health record. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) in the electronic health record."
Time frame: 155 days after date of delivery
Receipt of recommended screening and counseling for chronic condition by primary care practitioner
For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as documented in the electronic health record.
Time frame: 365 days after date of delivery
Receipt of recommended screening for gestational condition by primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as documented in the electronic health record. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) in the electronic health record.
Time frame: 365 days after date of delivery
Receipt of recommended screening and counseling for chronic condition by primary care practitioner
For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as documented in the electronic health record.
Time frame: 548 days after date of delivery
Receipt of recommended screening for gestational condition by primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as documented in the electronic health record. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) in the electronic health record.
Time frame: 548 days after date of delivery
Self-report of receipt of recommended screening and counseling for chronic condition by primary care practitioner
For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as reported by the participant.
Time frame: 365 days after date of delivery
Self-report of receipt of recommended screening for gestational condition by primary care practitioner
For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as reported by the participant. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) as reported by the participant. "
Time frame: 365 days after date of delivery
Self-report of having a known, reliable primary care practitioner
Participant report of having a known, reliable primary care practitioner (doctor, nurse practitioner, or physician's assistant).
Time frame: 365 days after date of delivery
Urgent or emergent care use
Emergency department or urgent care visit for any reason as documented in the electronic health record.
Time frame: 155 days after date of delivery
Self-report of urgent or emergent care use
Emergency department or urgent care visit for any reason as documented as reported by the participant.
Time frame: 155 days after date of delivery
Urgent or emergent care use
Emergency department or urgent care visit for any reason as documented in the electronic health record.
Time frame: 365 days after date of delivery
Self-report of urgent or emergent care use
Emergency department or urgent care visit for any reason as reported by the participant.
Time frame: 365 days after date of delivery
Self-report of mental health
Edinburgh Perinatal Depression Scale score as reported by the participant.
Time frame: 365 days after date of delivery
Urgent or emergent care use
Emergency department or urgent care visit for any reason as documented in the electronic health record.
Time frame: 584 days after date of delivery
Interpregnancy interval
Defined as the time (in days) from date of delivery until subsequent date of conception.
Time frame: 365 days after date of delivery
Interpregnancy interval
Defined as the time (in days) from date of delivery until subsequent date of conception.
Time frame: 584 days after date of delivery
Prescription or documentation of medication use for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder
Observation of a prescription for or provider documentation noting the use of a medication for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder in the electronic health record.
Time frame: 155 days
Prescription or documentation of medication use for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder
Observation of a prescription for or provider documentation noting the use of a medication for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder in the electronic health record.
Time frame: 365 days
Prescription or documentation of medication use for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder
Observation of a prescription for or provider documentation noting the use of a medication for the treatment of a pre-existing or newly diagnosed mood or anxiety disorder in the electronic health record.
Time frame: 584 days
Contraception use
The use of any form of contraception as documented in the electronic health record
Time frame: 155 days
Contraception use
The use of any form of contraception as documented in the electronic health record
Time frame: 365 days
Contraception use
The use of any form of contraception as documented in the electronic health record
Time frame: 584 days
Self-report of contraception
Self-report of using contraception or discussing family planning/contraception
Time frame: 155 days
Self-report of contraception
Self-report of using contraception or discussing family planning/contraception
Time frame: 365 days
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