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JAMA health forum
Von Yee LM, Feinglass J, Williams BR und 8 weiteren.
Inhalt auf Englisch
Postpartum care in the US is fragmented and inadequate, with major disparities in quality. Patient navigation is a promising health services intervention to improve health care provision and reduce disparities.
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To evaluate whether postpartum patient navigation improved postpartum health care quality among people with low incomes.
This randomized clinical trial was conducted at a single urban academic medical center from January 2020 to July 2024 and included English- or Spanish-speaking pregnant people 16 years or older with Medicaid insurance. Data analysis started in October 2024.
Participants were randomly assigned to 1 year of patient navigation vs usual care. Those randomized to navigation received individualized services that were designed to overcome postpartum-specific barriers to care from a trained lay navigator.
The primary outcome, as ascertained from medical records, was receipt of 6 care elements considered to be essential to optimal postpartum care by 12 weeks postpartum. Secondary outcomes included the proportion of components received by 12 weeks and receipt of health services at 11 to 13 months.
A total of 405 people (mean [SD] age, 28.2 [5.7] years; 10 [2%] were Asian, multiracial, or another race; 166 [41%] were Hispanic; 202 [50%] were non-Hispanic Black; and 27 [7%] were non-Hispanic White) were randomized (203 [50%] in patient navigation; 202 [50%] received usual care). The frequency of the primary outcome (ie, receipt of all 6 essential components of postpartum care) was similar between the groups (19 [9.4%] in patient navigation vs 16 [7.9%] in usual care; P = .60). However, the mean (SD) proportion of components received was significantly higher among navigation recipients (71% [17%] vs 64% [23%]; P = .002). Three components drove this difference: postpartum visit completion (195 [96%] vs 161 [80%]; P < .001), receipt of all indicated anticipatory guidance (131 [65%] vs 104 [51%]; P = .01), and postpartum depression screening and care (174 [86%] vs 145 [72%]; P < .001). At 11 to 13 months, participants randomized to navigation were more likely to have attended a primary care visit, be using their desired family planning method, and have received depression screening and linkage, cardiometabolic screening, and recommended vaccines.
The results of this randomized clinical trial suggest that although patient navigation did not result in a higher frequency of achieving all 6 components of postpartum care, the proportion of care components received was significantly higher. At 1 year postpartum, those randomized to patient navigation demonstrated multiple improved health services outcomes, including more frequent transition to primary care.
ClinicalTrials.gov Identifier: NCT03922334.
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